Oral Answers to Questions

SCOTLAND

The Secretary of State was asked—

Free Television Licences

David Marshall: How many pensioners in Scotland receive the free television licences for people over 75 years of age.

George Foulkes: More than 300,000 pensioners in Scotland benefit from free television licences, but this measure forms just part of our overall package of generous support for pensioners.

David Marshall: I thank the Minister for his reply, which shows just what an excellent and worthwhile measure that is. Will he convey to his ministerial colleagues the suggestion that the qualifying age should be reduced from 75 to 70? In view of the difficulties that many poor people and those on low incomes have in meeting the ever- increasing cost of the television licence fee, will he also convey to them that now is perhaps the time to consider alternative methods of funding the BBC?

George Foulkes: I am grateful to my hon. Friend for his initial helpful remarks. As far as funding the BBC is concerned, it has been looked at a number of times and this and previous Governments concluded that the licence fee is the best way to achieve that. On reducing the age of qualifying for free television licences, perhaps my hon. Friend and, indeed, I might have to declare an interest in that in the near future.
	As you know, Mr. Speaker, I used to be director of Age Concern Scotland, and we had a number of demands for the then Tory Government, none of which was accepted. This Government have implemented those demands one by one by one, including free television licences for the very elderly, who are less able to take advantage of other things, such as concessionary fares. That shows the generous way in which the Government have dealt with our old people.

Annabelle Ewing: As we are discussing benefits that are available to pensioners in Scotland, are the Minister and his colleagues in the Scotland Office disappointed that the dead hand of Westminster has put paid to free personal care for Scottish pensioners as originally envisaged, or are he and his—

Mr. Speaker: Order. The hon. Lady should sit down. She is going way beyond the scope of the question, so the Minister should not respond.

Brian H Donohoe: Can the Minister give an idea of the cost of reducing the age of those eligible for free television licences from 75 to 65?

George Foulkes: I cannot off the top of my head give an exact figure, and I am sure that my hon. Friend would not expect me to. What I can tell him is that the cost would be very substantial and we would have to consider it in the light of all the other demands placed on the budget, especially as they relate to the elderly. I think that it was more important to introduce the £200 winter fuel allowance for every old person than it was to provide free television licences for them, which would be very expensive.

Regulation

Mark Prisk: How many new regulatory measures affecting Scottish business the Government have (a) introduced and (b) abolished since 1999.

Helen Liddell: In introducing new regulations, the Government are very careful to take account of the needs of the business community.

Mark Prisk: I am grateful for that concise reply. Given that small businesses in Scotland spend more than 31 hours every month trying to comply with regulations, does the Secretary of State agree that those regulations represent a burden and put Scottish businesses at a competitive disadvantage? Does she also agree that the improving regulations in Scotland unit has failed in its particular task?

Helen Liddell: No, I do not agree with the hon. Gentleman, and I know something about the small business community in Scotland, having previously run a small business, having been a sole trader and having set up other small businesses. I believe that the small business community in Scotland, like the overall business community in Scotland, is very grateful for the fact that since 1997 the Government have reduced corporation tax by nearly 25 per cent. In addition, we are committed to extending the 10p corporation tax rate, we are reducing and simplifying value added tax procedures and our capital gains tax regime is one of the simplest in the world and much more favourable than that in the United States. Indeed, in introducing what is in effect an MOT on regulation, which ensures that regulations are checked on a 10-yearly basis, the Scottish Executive are taking the sensible way forward, and it has been mirrored in the approbation that the small business community has shown towards such an approach.

Bill Tynan: Is my right hon. Friend aware of the recent Trades Union Congress research on the burden of regulation on business? Does she agree that at 5p a week, the cost of maternity provision is certainly a price worth paying for women of child-bearing age? Does she also agree that issues such as fire prevention, which costs less than 1p a week, are very important? If our businesses honoured their responsibilities, we would not need such legislation.

Helen Liddell: My hon. Friend makes a good and important point. In reality, much regulation is aimed at ensuring that the good employers who implement good conditions of work for their employees are not undercut by unscrupulous cowboys. Indeed, I draw attention to the fact that the national minimum wage has transformed the lives of 135,000 Scots. The benefits of regulation far outweigh the costs. Notwithstanding that, the Government have been anxious to ensure, through the introduction of the Small Business Service, that the level of regulation is proportionate, so that small firms continue to grow and our economy becomes even more competitive.

John Thurso: Is it not the case that much unnecessary regulation in Scotland comes from the Government's block on using derogations available under EU legislation? In that regard, will the Secretary of State seek to persuade the Secretary of State for the Environment, Food and Rural Affairs to use the derogations available to alleviate the plight of small farmers and crofters who are drowning under a sea of paper?

Helen Liddell: One of the Government's commitments is to be an active player in the European Union, but we also want to make sure that the systems under which we operate are proportionate and suited to the operation of our economy and our industries. I believe that we are doing that. In 1997, Britain was very much on the sidelines of Europe, and we have since become leaders in the EU. As a consequence, we are able to have a much greater impact on regulation to suit the economy not only of the urban but of the rural community.

John McFall: May I caution the Secretary of State against the siren voices that call for complete absence of regulation? We are mindful of the financial scandals that are occurring—for example, those concerning Independent Insurance Co. Ltd. and Equitable Life, whose policyholders are writing to us. We need to exercise a light regulatory touch while fostering economic progress. Is not the big issue in Scotland's economy today the historically low growth of Scottish businesses? There is a need for the Government and local communities to ensure that those businesses are stimulated so that their growth equals the UK average and there are least 200,000 more people in employment.

Helen Liddell: I very much agree with my hon. Friend. Like most Members of the House, whenever Equitable Life is mentioned I have to declare an interest because, again like most Members, I have policies with that company. It is important that we create the proper climate for entrepreneurship so that new firms can be set up. Historically, Scotland has a problem with the formation of new firms, and the Government and the Scottish Executive are working together to address that. At the same time, there is a need for transparent and easily understood regulation to ensure that the most vulnerable in our communities—in that group I include pensioners and those nearing retirement age—have the maximum protection available.

Greg Knight: Will the Secretary of State come clean and admit to the House that Labour's extra burdens on business are destroying jobs? Is she aware that, in 2001, 20,842 jobs were lost in Scotland and that Britain as a whole fell from ninth to 19th in the world competitiveness league? How many more people have to lose their jobs before Labour realises that the business of government is not the government of business?

Helen Liddell: Despite the fact that many members of the right hon. Gentleman's party lost their jobs in 1997—losses that were consolidated in 2001—I point out that Scotland has the highest levels of employment and the lowest levels of unemployment for more than a generation. Perhaps if he knew rather more about Scotland he would be able to understand that, and he would be prepared to join me in congratulating those businesses that have created jobs in Scotland and those people who have moved themselves from welfare into work, particularly the long-term unemployed, and he would be prepared to recognise the scale of the achievement in Scotland. There are more people in work now than there were when his Government left office in 1997.

Friends of Scotland

John Lyons: What plans she has for future activity as part of her Friends of Scotland initiative.

Helen Liddell: At the end of this week I shall travel to Hong Kong and Guangzhou in China and to Malaysia on trade-related business, and I shall take the opportunity to launch the Friends of Scotland initiative there. Indeed, in all my international travels I shall make a point of raising the initiative, both with posts abroad and with the expatriate Scottish community.

John Lyons: I thank my right hon. Friend for that response. It is important that we use her visit to make sure that millions of Scots all over the world know about Friends of Scotland and know that they can play a part in the initiative. To some extent, we are pushing an open door. People want to help and we need to use my right hon. Friend's visit to say to people, "If you want to come back to Scotland on holiday or on business, you will be made very welcome and you can play an important part in shaping Scotland's future."

Helen Liddell: I thank my hon. Friend. I am looking forward to attending a Burns supper in Hong Kong next Tuesday night, and I shall certainly make a point of reiterating the fact that we always welcome expatriate Scots who return to Scotland. My hon. Friend made an important point. I am have been much taken with the response of the business community and people in diplomatic posts abroad and their enthusiasm for the Friends of Scotland initiative, which has been helped by the ready response to it from the Prime Minister, the Foreign Secretary, the First Minister and the leaders of Scotland's business and commercial communities.
	We are pushing at an open door and it is incumbent on every Member of Parliament, regardless of which political party they support, to do what they can to encourage expatriate Scots and those who regard themselves as friends of Scotland to come back and visit Scotland and see the changes that have taken place, not least the establishment by the Labour Government of the Scottish Parliament, of which Robert Burns would have approved.

John Barrett: Does the Secretary of State agree that some of the best friends of Scotland work in the film, television and music industries and that one of the best ways to help them in their work promoting Scotland throughout the world would be an early start to the construction of a central Scotland film studio?

Helen Liddell: Matters such as the construction of a film studio are for the Scottish Executive to deal with, but I entirely support the hon. Gentleman's point about the importance of the creative industries, particularly film and television. We have only to consider the huge success of "Monarch of the Glen", which is now viewed by 50 million people, to see that it is a fantastic showcase for the highlands of Scotland. I was glad to be able to support that with a reception in Dover house just before Christmas. The advisory committee that I have formed to help me with the Friends of Scotland initiative includes Douglas Rae who, of course, is the producer of "Monarch of the Glen" and the upcoming new film "Charlotte Gray".

Iain Luke: When my right hon. Friend makes her visit to east Asia, on which I warmly congratulate her, will she take the opportunity to reach out to the many thousands of Malaysian students who have studied in Scottish universities, many of whom have got degree certification at their universities through a joint partnership with the university of Abertay in Dundee? Will she use the connections that she will make with Malaysian business men who have graduated from Scottish universities to bolster Scottish commerce and trade in future?

Helen Liddell: As the hon. Member for Beckenham (Mrs. Lait), my Opposition shadow, well knows, Scottish universities have strong links, especially with Malaysia. She and I, as graduates of Strathclyde university, know about huge initiatives in Malaysia, particularly in business education. I know from the connections of my hon. Friend the Member for Dundee, East (Mr. Luke) with the university of Abertay that he is well aware of the huge opportunities available there.
	My officials have met, and are meeting, representatives of the Scottish universities so that we can join together to promote Scottish education internationally. In both China and Malaysia, I intend to meet representatives of the academic community so that we can showcase the best of Scottish education and the huge benefits that our economy derives from students from the far east coming to Scotland, particularly to get postgraduate degrees.

Roy Beggs: I congratulate the Secretary of State on the Friends of Scotland initiative and I look forward to the day when we have a dedicated Westminster Minister to promote friendship with Northern Ireland as well. When the Secretary of State is in the far east, I hope that she will be mindful of the near west and the strong Ulster Scots tradition in Northern Ireland. We are willing to be supportive and trust that she will develop further the existing links with Northern Ireland.

Helen Liddell: I thank the hon. Gentleman very much for his supportive remarks. I know that my right hon. Friend the Secretary of State for Northern Ireland is very much a friend of Northern Ireland and, indeed, a friend of Scotland. As the Prime Minister has recognised, in showcasing all the component parts of the United Kingdom we present an even more attractive picture of the UK, not just to tourists but to bring in inward investment. Our standing in the world is high at the moment; this is an ideal opportunity for us to cement warm feelings for all the component parts of the UK, wherever we work internationally.

Barnett Formula

Nicholas Winterton: When she last discussed the future of the Barnett formula with Treasury Ministers.

George Foulkes: My right hon. Friend the Secretary of State and I have regular discussions with Treasury Ministers on a wide range of issues. I can tell the hon. Gentleman and the House for the third time that there are no Government plans to review the Barnett formula.

Nicholas Winterton: I ask my supplementary question as a totally committed Conservative and Unionist Member of the House. Does the Minister accept that the Barnett formula was introduced some two decades ago as a temporary measure, and that it currently produces levels of public expenditure per capita in Scotland far greater than in many areas of England, where there are equal problems of poverty and deprivation? For that reason, does he not believe that the current situation is unfair? Although he speaks as a Scottish Minister, does he not believe that there should be a review and reform of the Barnett formula, despite his initial response to my question?

George Foulkes: I have never doubted the hon. Gentleman's Unionist credentials. One of the reasons why I enjoy Scottish questions is that I hear English Tories such as the hon. Gentleman say that the Barnett formula is far too generous to Scotland. I am fed up of hearing the other point of view—the moaning minnies, the whingers of the Scottish National party, saying that the formula is unfair to Scotland. The truth is that the Barnett formula is stable, flexible and fair. If the English Tories think that it is too generous and the SNP thinks that it is too mean, I think that it is just about right.

David Stewart: Does my hon. Friend agree that the Barnett formula has brought tremendous benefits to Scotland? For example, in 1997 when the Government came to power, the Scottish Office spent £15 billion. Today, the Scottish Executive spends almost £21 billion. Is not that the benefit of Scotland being within the United Kingdom?

George Foulkes: There speaks the real voice of Scotland. It is the success of the United Kingdom Government's economic strategy and our policies that enable the Scottish Executive to have the extra money to spend. An extra £3.4 billion of new money has been spent in Scotland over the period of the current spending review, plus an extra £200 million in last year's Budget, and, as if that were not enough, an extra £86 million in the pre-Budget review. I wish that some of those who try to pretend that they represent Scotland would understand, appreciate and acknowledge that.

Jacqui Lait: As health spending comes under the terms of the Barnett formula, can the hon. Gentleman tell us whether Scotland Ministers have had discussions with the Department for Work and Pensions or the Scottish Executive since 12 October last year on the subject of attendance allowance for the elderly receiving free personal care in Scotland, what advice they have given, and whether they would be prepared to publish the correspondence?

George Foulkes: I am extremely grateful to the hon. Lady for asking me that question. I can therefore announce to the House that the Executive have announced today, after dialogue with the Department for Work and Pensions and other Whitehall Departments, that they will meet the full cost of delivering free personal care from within Executive resources.

Jacqui Lait: I am delighted that the Scottish Executive have resolved the dilemma that they had with Whitehall, but that does not negate my question about the discussions that Scotland Office Ministers have had. For the sake of clarity, can the Minister tell us whether he or the Secretary of State backed the transfer of funds from Whitehall to Scotland or supported the Scottish Executive?

George Foulkes: I had a number of discussions with Malcolm Chisholm during the consideration by the care development review. I made the views of Whitehall extremely clear on every occasion.

Economic Trends

Alex Salmond: When she last met the Chairman of Scottish Enterprise to discuss trends in the Scottish economy; and if she will make a statement.

Helen Liddell: I meet regularly with a wide range of bodies and people to discuss aspects of the Scottish economy, including Scottish Executive Ministers and senior officials from Scottish Enterprise. The fundamentals of the Scottish economy as part of the United Kingdom remain strong—high levels of employment, low levels of unemployment, strong public finances, low inflation and the lowest interest rates since the 1960s.

Alex Salmond: Is the Secretary of State aware that, since she told us last month that the Scottish economy had been performing well, there have been further thousands of job losses in Scotland? We are only three months away from the imposition of the aggregates tax, which will take another £40 million out of the Scottish economy and increase the cost of every infrastructure project in every constituency and council area of Scotland. Now that the Northern Ireland Assembly has successfully negotiated with the Treasury exemption from certain aspects of the aggregates tax, will she open discussions with the Treasury, or will we have another swindle in which, as we have just heard, Whitehall Departments take more money out of the Scottish economy, with further thousands of job losses in Scotland?

Helen Liddell: Not only is the hon. Gentleman content to whinge for Scotland, but he does not even care about its environment. The extent of his self-interest is dramatic. This is the man who was going to leave Parliament and decried us; he was going to go to the Scottish Parliament and then he was going to come back. At Christmas time he told us that the Scottish Parliament would soon be good enough to accept him back. There is no end to his self-interest—

Mr. Speaker: Order. The Secretary of State should tell us about her policies, not those of the hon. Member for Banff and Buchan (Mr. Salmond).

ADVOCATE-GENERAL

The Advocate-General was asked—

Sewel Motions

Alistair Carmichael: If she will make a statement on the operation of the Sewel motions procedure.

Lynda Clark: The Sewel motions procedure, which is reflected in the memorandum of understanding between the Government and the devolved Administrations, states that this Parliament would not normally legislate with regard to devolved matters without the agreement of the devolved legislature. The devolved Administration are responsible for seeking such agreement. Sewel motions are the method by which the Scottish Executive seek to obtain the agreement of the Scottish Parliament. They are a matter of practice, not law. A Sewel motion, whether it is approved or not, has no bearing on the legislative competence of the Scottish Parliament, as set out in the Scotland Act 1998, or on the legislative competence of the UK Parliament.

Alistair Carmichael: I thank the Advocate–General for that answer, but does she agree that the operation of Sewel motions presents a number of practical problems? It does not allow Members of this House to question the Ministers who have direct executive responsibility, because they are part of the Scottish Executive. Will she have discussions with the Leader of the House to ensure that, in future, when legislation that comes before this House as the result of a Sewel motion has been given its Second Reading, it will be committed to a Special Standing Committee under Standing Order No. 91, which will allow evidence to be taken from Scottish Ministers?

Lynda Clark: I regret to tell the hon. Gentleman that I see no reason whatever to enter into such discussions with my right hon. Friend the Leader of the House. Of course, he is entitled to enter into such discussions if he wishes to do so.
	On procedure in the Scottish Parliament, it is entirely a matter for that Parliament to decide how to deal with the motions. As for procedure in this House, the UK Parliament always has competence to deal with these matters. Hon. Members are always entitled to raise any issues about which they want to speak that are within that competence.

Ian Davidson: Does the Advocate-General accept that the Proceeds of Crime Bill, which is currently travelling through the House, is a very good example of legislation that has been supported by the Scottish Executive and by the Government in this House and that it will bring enormous benefits to Scotland? Does she agree that, rather than trying to invent mechanisms to cause difficulties, the Liberals, whom I thought were our chums, would be much better advised to co-operate with us in processing the Bill as quickly as possible?

Lynda Clark: My hon. Friend makes a very important point. The Scottish Parliament has co-operated on many occasions with the UK Government in order to bring forward legislation, probably more quickly than the Scottish Parliament alone might have done, bearing in mind its heavy legislative programme. The Proceeds of Crime Bill is a very good example of that. Therefore, my view is that the two Parliaments are working well together to help the citizens of Scotland to get the sort of legislative programme that they deserve.

Human Rights (Devolution)

Anne McIntosh: When she last had discussions with the Scottish Executive on human rights cases involving devolution.

Lynda Clark: My officials and I have discussions with the Scottish Executive when necessary about devolution issues that raise human rights points.

Anne McIntosh: Following my supplementary question on the same point during Question Time last month, will the hon. and learned Lady confirm that she intervened in 20 cases? Rather than simply saying that she has saved money, will she explain, without false modesty, what added value she has brought to her position?

Lynda Clark: I think it was 20 cases—I thought I had written to the hon. Lady about that. I shall give her the exact figure, which is in that region. I cannot go through the whole 20 cases now, but I intervene in cases for a range of reasons. For example, I might wish to bring to the court's attention the position of the law in England and Wales. In the misuse of drugs legislation, it was important to clarify the position and its effect in England and Wales. The reasons therefore differ in the 20 cases. I am more than happy to hold informal discussions with the hon. Lady about them.

LORD CHANCELLOR'S DEPARTMENT

The Parliamentary Secretary was asked—

Lay Magistracy

Henry Bellingham: What plans he has to encourage more applications to join the lay magistracy; and if he will make a statement.

Michael Wills: The Lord Chancellor's local advisory committees tailor recruitment initiatives to local needs so that magistrates benches are representative of the community. In Norfolk, the advisory committee participated, for example, in a regional television broadcast and had interviews with magistrates published in the local press. Such activities led to an increase in the number of magistrates in Norfolk from 13 in 1997 to 30 in 2001.
	The Lord Chancellor has commissioned a national strategy for recruiting lay magistrates, which will be announced shortly.

Henry Bellingham: I am grateful for that reply, but the Government are not doing enough. Is the Parliamentary Secretary aware that a record number of lay magistrates resigned last year? Many of those in my constituency cited low morale and a sense of being undervalued by the Government. Is he also aware that 22 magistrates courts closed last year and that Fakenham court in west Norfolk is threatened with closure? That makes local justice more remote from local people, not least because the local press does not report cases in much detail. Why do not the Government do more for local justice?

Michael Wills: The hon. Gentleman did not listen to my answer. I explained that the number of magistrates recruited in Norfolk increased from 13 in 1997 to 30 in 2001. That hardly squares with his allegations of a lack of interest or morale among those who wish to be magistrates. We take local justice seriously, but he knows that the closure of magistrates courts is a matter for magistrates courts committees.

Peter Pike: My hon. Friend knows that the Chancellor of the Duchy of Lancaster has, through the advisory committee for the appointment of magistrates in Lancashire, tried to achieve a better representation of people on the magistrates bench. Does he appreciate that employers make it increasingly difficult for working people to take time off to be a lay magistrate? Can we do more to ensure that employers recognise that we need ordinary working people to serve on the magistrates bench and that that is an important element of justice in this country?

Michael Wills: My hon. Friend is right. That is why the Department is supporting the Magistrates Association project, which tries to draw employers' attention to the transferable skills that magistrates acquire through their work and training, apart from the civic appropriateness of people serving as magistrates.

Simon Hughes: Does the Parliamentary Secretary accept that the number of magistrates will increase and people will be encouraged to join the magistracy by a confirmation that Government policy under the Auld proposals and the subsequent legislation supports an increase, not a reduction? Will he confirm that it is Government policy to increase the number of lay magistrates in England and Wales, not reduce them? Does he have figures to show the number of new appointments of people aged between 18 and 38, not between 38 and 58, since the Labour party came to office in 1997? Without significant new recruitment of younger people, we shall have an imbalanced bench, which is unrepresentative of the community with which it deals.

Michael Wills: I agree with the hon. Gentleman on the need to ensure that magistrates benches are properly diverse and represent the communities that they serve, and that is clearly something that we strive to achieve. I do not have the figures for precisely those age breakdowns to hand, but I shall be happy to write to him with the details. He will be aware that we are still consulting on the proposals made by Lord Justice Auld, so I am not in a position to announce policy on the matter today, but I can assure him that the House will have plenty of opportunity at the appropriate time to debate our responses to Auld.

Magistrates Courts (Fines Enforcement)

Peter Luff: What assessment he has made of the effectiveness of the system for enforcement of payment of fines by magistrates courts; and if he will make a statement.

Michael Wills: Responsibility for warrant execution for non-payment of fines was transferred from the police to magistrates courts committees on 1 April 2001. The Lord Chancellor's Department conducted a review of the new enforcement regime and concluded that, although there is significant room for improvement, the foundation has now been laid for the more effective enforcement of fines in future.

Peter Luff: I am encouraged by that reply, as it suggests that the anecdotal evidence collected by me and other hon. Members that there is quite a serious problem with the enforcement of fines in magistrates courts is correct. Will the Minister do all in his power to make it easier for people to pay their fines—for example, whenever possible by retaining the facility to pay fines at the point of delivery, the magistrates court?

Michael Wills: Of course we acknowledge that the situation is not all that it should be and that is why we are taking a range of actions to ensure that performance is better in future. We have been encouraged by the performance so far, but it could be still better. Of course the Government believe that defendants should be given the opportunity to pay their fines promptly and conveniently. A range of methods is now available for paying fines—for example, cash, cheque, credit and debit cards, bank giro, Transcash and Paypoint—so it is not absolutely necessary for there to be a cash office in every courthouse in the country. Furthermore, the hon. Gentleman will be well aware from his own experience that the closure of cash offices is a matter for individual magistrates courts committees.

William Cash: Would the Minister be surprised if I pointed out to him that I am anything but encouraged by the way in which this system is operating? To give just one example, in London the latest figures show that the fines imposed in magistrates courts amount to £92 million but, astonishingly, the fines collected are no more than £41 million, which I think the Minister knew when he got up to speak. Does he also accept that the Lord Chancellor has effectively declined to provide additional resources to make up the difference—so much so that a number of judges have been writing to one another complaining bitterly on behalf of prosecutors, the police, the Prison Service, probation officers and others? Will the Minister do something about that?

Michael Wills: The answers to those questions are no, no and yes. No, I am not surprised that the hon. Gentleman makes the point that he does. No, I do not accept that we have not made extra resources available. In 2001–02, £14 million has been allocated for the enforcement of fines and, as a result of the netting-off scheme, of which the hon. Gentleman will be well aware, magistrates courts committees will have nearly £10 million extra to spend on enforcement during the next two financial years. Finally, of course we will do all that we can to improve the record. It is not as good as it should be, and we are taking a wide range of actions to ensure that it gets better in future.

Patient Advocacy and Community Legal Service (NHS)

Kelvin Hopkins: If he will take steps to promote the establishment of a patient advocacy liaison service and community legal service information point in every NHS hospital.

Rosie Winterton: The Lord Chancellor's Department supports the development of community legal service information points in places that can be easily accessed by members of the public. This includes primary health care outlets such as general practitioners' surgeries and NHS hospitals, where we are considering ways in which links might be established with the new patient advocacy liaison service.

Kelvin Hopkins: My hon. Friend will know that, at my local hospital, the Luton and Dunstable, we have the first such facility in the eastern region, and that, so far, it has been a great success. It has been welcomed unanimously by staff and patients. I made inquiries today and found out that, in its first quarter of operations, patient complaints went down by 21 per cent. and, year on year in December, they were down by 59 per cent. Does my hon. Friend agree that that makes a powerful case for every hospital having such a facility?

Rosie Winterton: I am well aware of the project in my hon. Friend's constituency, and I also know that the support that he has given to it personally has been extremely welcome. Luton and Dunstable hospital was the first hospital to be quality marked as a community legal service information point. We shall certainly consider whether the project could be an example of good practice that we could encourage other hospitals across England and Wales to follow.

Martin Smyth: Has the hon. Lady been in touch with the Department in Northern Ireland to make sure that such a system is working there? Is she aware that, at times, the patient advocacy liaison service apparently advocates more for hospitals than for patients?

Rosie Winterton: The hon. Gentleman is aware that the particular aspect for which I have responsibility is the community legal service, but I am sure that his comments will be noted by other Ministers. I can assure him that we are trying to ensure that there are community legal service information points in as many places as possible, including GP surgeries and NHS hospitals.

Asylum Seekers (Appeals)

Fiona Mactaggart: How many appeals against refusal of asylum have been lodged and are awaiting a hearing.

Rosie Winterton: Of the 32,874 cases received by the Immigration Appellate Authority between 1 April and 30 November 2001, 11,554 asylum cases were awaiting a first substantive hearing as at 30 November. The remaining 21,300 were either completed, under consideration or awaiting a further hearing at either adjudicator, application for leave to appeal or tribunal stage.

Fiona Mactaggart: I thank my hon. Friend for her reply. We have had exchanges about delays in those appeals for some time and I know that she is putting a lot of effort into trying to improve the situation, but I am concerned about that group of appeals for which notification of the result comes from the Home Office, not her Department, following the changes to the regulations. What steps has she taken to ensure that the Home Office gives that notification swiftly to an appellant whose appeal has been refused? If it does not provide notification in a reasonable time, will she take action to ensure that appellants know the results of their appeals? We all know that the Home Office is not exactly a speedy animal when dealing with immigration and asylum matters.

Rosie Winterton: I understand my hon. Friend's point and I know that she takes a close interest in the issue. Perhaps it will help if I explain the process. The Home Office will sift appeal determinations to identify those suitable for delivery in person. Resources will initially be focused on delivering decisions in person to failed asylum seekers who are at risk of absconding and whom it is possible to remove. Increasing the number of decisions delivered personally and speedily will depend on evaluating the success of the new measures and the gradual introduction of the new reporting centres, accommodation centres and removal centres. I hope that that reassures her.

Nick Hawkins: The Minister is aware that, following a day of pressure from Conservative Members yesterday, led by my hon. Friend the Member for West Dorset (Mr. Letwin), the shadow Home Secretary, the Home Secretary finally agreed late in the afternoon that special arrangements would be made for asylum claimants from Zimbabwe. They will not be returned, rightly in my view, but what will be the effect on her Department, now that the Home Secretary has wisely changed policy?

Rosie Winterton: Home Office policy has obviously—[Hon. Members: "Changed."] The change that the Home Secretary announced is that removals to Zimbabwe are temporarily suspended until after the March elections. The Home Office will continue to monitor the situation with a view to making a reassessment after the elections. In terms of the effect on the asylum system, outstanding cases will be considered in the light of those new decisions.

Sonia Deary

Colin Pickthall: If he will make a statement on progress in the case of Sonia Deary.

Rosie Winterton: The question concerns the progress of a long-standing High Court claim by Sonia Deary for an increased share in the estate of her late husband. The resolution of this claim is dependent on her and her solicitor either agreeing a settlement with other family members or bringing the claim to trial. I understand that the legal proceedings have recently been revived and I would not wish to comment further on a pending case.

Colin Pickthall: I am grateful to my hon. Friend for her reply and for her energy in pursuing this case since she assumed her office. Does she agree that whoever is to blame for the delay—I noted carefully what she said on that score—it is unacceptable for any citizen to have to wait for more than 16 years for an estate to be settled? Does she agree that it is at least part of the functions of the Lord Chancellor's Department to seek to clarify, simplify and streamline the systems in such cases to avoid circumstances in which British citizens find themselves akin to characters in "Bleak House"?

Rosie Winterton: I am well aware of my hon. Friend's interest in the matter and I know that he has done everything that he can to assist his constituent. I am sure that he is also aware that this is an extremely complicated case. The intimate family and financial details of the estate should not be discussed in the House, but the role of the Official Solicitor and the matters that he has to deal with in such cases can be extremely complex. The time taken to resolve an estate might depend on many issues. For example, the deceased might have assumed several identities or outstanding business problems might need to be resolved. In that situation, the Official Solicitor should of course act expeditiously, but we must recognise that the cases can be complicated.

HOUSE OF COMMONS

The President of the Council was asked—

Oath of Allegiance

Nicholas Winterton: What proposals he has to reform of the Oath of Allegiance for hon. Members taking their seats in the House.

Robin Cook: The form of the Oath is prescribed by statute. The Government have no plans to amend it.

Nicholas Winterton: The Leader of the House will appreciate the reason for my question and, I am sure, my total commitment to this place. Does he believe that anyone who becomes a Member of Parliament should have a true allegiance to the country in whose Parliament he or she seeks to serve? Is not there a danger in what the Government have done recently that we will establish two classes of Member of Parliament, which is a dangerous precedent indeed?

Robin Cook: I fully recognise the commitment of the hon. Gentleman to this place and the service that he has given to it. I assure him that I fully endorse his view that people should not take their seat here unless they are committed to making a success not only of this place but of the nation that this place represents. That is why we have made no change that would enable any of the Sinn Fein Members—or anybody else who does not take the Oath or affirm—to take their seats, to take part in votes or to speak. On the issue of two classes of Member of Parliament, I take the view that what we did in December erodes the distinction between those who have not taken the Oath and those who have in relation to allowances and access to this place, but in no way does it erode the difference between those of us who take our seats and those who do not.

Appointments Commission

Gordon Prentice: If he will invite the House of Lords Appointments Commission to discuss with people's peers their experience of their membership of the Lords with a view to informing its future recommendations.

Robin Cook: The first round of appointments made by the Appointments Commission included the chief executive of Centrepoint, the chief executive of Childline, and a trustee of Oxfam. The appointments also brought a welcome balance to the membership of the Lords. [Interruption.] I shall get to the question, if Members will be patient. Almost a third of the new members belong to ethnic communities and a similar proportion are women. They have brought their experience and authority to proceedings in the Lords on immigration, child poverty, equal opportunity and public services. I cannot speak for the Appointments Commission but I am sure that both my hon. Friend the Parliamentary Secretary and I would listen with respect if its members wished to comment on their experience.

Gordon Prentice: If appointed peers are expected to make a contribution in the House of Lords, is the chair of the Appointments Commission setting a good example by having spoken twice in the two and a half years since he was ennobled in 1999?

Robin Cook: I do not think that it is any part of my remit or that of the Government to encourage even more people to speak in debates in the House of Lords.

Paul Tyler: In addition to taking advice from the Appointments Commission and the people's peers, will the Leader of the House say what his proposals are for a further consultation period beyond the end of this month? He will be aware of the gathering consensus that the White Paper represents nobody except the Lord Chancellor, and that he is in a minority of one. What steps will the Leader of the House take to ensure that the House and the other place have a proper opportunity—without the Whips and on a free vote—to discuss the issues, and when does he expect us to be given that opportunity? Does he accept that there is one thing on which there is a unanimous view—that doing nothing is unacceptable?

Robin Cook: I wholly endorse the last sentence of the hon. Gentleman's question, and since it is the only part of his question that I can wholly endorse, I shall seize upon it. It is important that we continue the process of reform of the House of Lords to create a modern second Chamber. As I warned last week, we must not let divisions among those who want reform to prevent there from being any reform. We had a full opportunity for the House to express itself last week and, as someone who sat through the entire debate, I can say that the House expressed itself robustly. The views expressed last week are being reflected upon. The consultation process goes on until 31 January. It is perhaps premature now to announce any further consultation. It is important that we reflect on the views expressed in the House and in the country and, as I said last week, seek to find the centre of gravity that will enable reform to proceed with support.

Dennis Skinner: If only the Government had kept to the 1976 policy and abolished the House of Lords, they would not be suffering all this heartache at the present time. It is sad that nobody knows what the new proposal will be at the end, despite all the consultation that is taking place. In the knowledge that there are not enough Members like myself who want to abolish the House of Lords completely, irrespective of the percentage who are elected, my right hon. Friend must remember one thing—do not give it very much power.

Robin Cook: I can certainly assure my hon. Friend that I am in no danger of forgetting that very important maxim. It is precisely because of that that I sought to warn the House last week of the danger of a wholly elected second Chamber. I find it hard to see how we could preserve the present supremacy of the House of Commons and the present balance of power between us against a second Chamber that would claim an equally valid democratic mandate.
	With regard to my hon. Friend's first point, I do not wish to rehearse the debates of 1966.

Dennis Skinner: 1976.

Robin Cook: 1976. I have enough difficulty rehearsing the debates of last week. However, it has been the case in the past, particularly in the 1966 Parliament, that what stopped reform was division among the reformers. We must not let that be the case now.

Greg Knight: Before the Leader of the House has any discussions with the Appointments Commission, will he confirm that his own proposals for reform of the Lords, which were criticised in every quarter of this House last week, are in effect now a dead duck? Will he seek to use his influence with the Prime Minister—however great or small that might be—to ensure that the correct way forward is to propose a House of Lords where the majority of the membership is elected, not where the majority in the House are Tony's cronies?

Robin Cook: Without getting engaged in a discussion about the extent of my influence with the Prime Minister, I suspect that, such as it is, it would be sharply diminished if I announced to the House in advance what my advice would be.
	The right hon. Gentleman has to take on board the fact that Conservative Members must also face up to problems with their proposals, as some Labour Members have pointed out. The Conservative party has supported the hereditary principle for a century, so it is entirely welcome that it has finally recognised that that principle is indefensible, and has been so throughout the century that the Conservative party has defended it.
	I welcome the Conservative party's move towards democracy, but its proposals show that it believes that democracy means providing in the second Chamber the same representation for Surrey as for London. That shows that Conservatives have some way to go before they understand democracy as it is understood in Britain, and certainly as it is understood in London.

Information Technology

Michael Jack: If he will ask the Select Committee on Modernisation of the House of Commons to consider in what further ways the use of Information Technology can assist the work of hon. Members.

Stephen Twigg: The memorandum from my right hon. Friend the President of the Council to the Modernisation Committee raised a number of ways in which information technology might be used to assist hon. Members, ranging from electronic voting in the Lobbies to ways of giving opportunities for communication between members of the public and Members of the House.
	I believe that the Select Committee on Information may soon look at the issue of information technology in the House, and I very much hope that the Modernisation Committee will draw on its work.

Michael Jack: I thank the Minister for again giving an enthusiastic and encouraging reply. As part of his agenda of action, will he look at the possibility that Departments might send answers to parliamentary questions by e-mail? Will he also investigate the feasibility of a case-tracking system, so that hon. Members might know where letters go to when they disappear into the black hole that is a Department, and of supplying information electronically to hon. Members about what has happened to them? Finally, has any progress been made on the question of using laptop computers in Committees of the House?

Stephen Twigg: I congratulate the right hon. Gentleman on the persistence with which he has pursued that final point. I believe that the matter will be addressed by the Information Committee and the Chairmen's Panel. The right hon. Gentleman also raised some broader issues, some of which fall within the Modernisation Committee's remit, but others of which fall within the remit of the newly established Cabinet Committee on e-democracy. My right hon. Friend the Leader of the House will chair that Committee, which will have its first meeting next week. I shall ensure that the matters raised by the right hon. Gentleman are drawn to the Committee's attention.

Jimmy Wray: When my hon. Friend the Minister looks at the rules governing the modernisation and constitution of the House of Commons, will he bear in mind that, as a member of the Council of Europe and the Western European Union, I find it very difficult to get oral questions accepted by the Table Office? The office will not allow my research assistant to hand in a question from me, so he has to run about to find a Member who is willing to hand in the question for him. Some Members are too busy and do not want to hand in a question.

Stephen Twigg: I am grateful to my hon. Friend for raising that matter, which clearly falls within the remit of the Modernisation Committee's discussions. We want to ensure greater flexibility, so that hon. Members from all parties can balance their commitments outside the House with their commitments here. I shall ensure that the point is considered in the Modernisation Committee's inquiry. The hon. Member for Roxburgh and Berwickshire was asked—

Parliamentary Commissioner for Standards

Peter Bottomley: To ask the hon. Member for Roxburgh and Berwickshire, representing the House of Commons Commission, which recent letters to the Commission from the Commissioner for Standards have not been published to hon. Members.

Archy Kirkwood: I understand that the letter of 28 November from the Parliamentary Commissioner for Standards to Mr. Speaker was released to the media on the evening of 4 December 2001. The Committee on Standards and Privileges requested on 9 January that the commissioner's letter of 14 December be published. The Commission will consider that request, and the commissioner's letter of 8 January, at its next meeting.

Peter Bottomley: I am grateful to the hon. Gentleman and to the Commission. It would be a happy thing if it agreed to publish the letters. Will the hon. Gentleman consider the report from the predecessor Commission that was published on 9 November 1998, and the words in the initial speeches in the debate of 17 November 1998? Tributes were paid to the then incoming Parliamentary Commissioner for Standards. I commend the words in that report that referred to her personal qualities, and the House will expect those sentiments to be reflected in the letters, when they are published.

Archy Kirkwood: Obviously, I cannot commit the Commission to anything, but I give the hon. Gentleman the undertaking that the matter will be given serious consideration. Important issues of precedent are involved, and we must be jealous of them. The correspondence between the Commission and senior officers of the House is not something that should easily be made transparently public on every occasion. We must therefore be careful that we do not establish precedents that could be dangerous in the future. However, I give the hon. Gentleman the undertaking that the matter that he raises, and the request from the Standards and Privileges Committee, will be given urgent consideration when the Commission meets early next week.

David Winnick: On the subject of the correspondence, is the hon. Gentleman aware that many people in the House and certainly outside it consider that the way in which the Parliamentary Commissioner for Standards has been treated is very shabby given the view, which I share, that she has carried out her duties very conscientiously? This matter is unfortunate and brings into question the self-regulation that exists for Members of Parliament.

Archy Kirkwood: I hope that when the hon. Gentleman sees the provisions that are made after the open process for the nomination and appointment of a successor to the current commissioner is completed, he will believe those fears to have been misplaced. An open competition is now in its final stages. The current commissioner has been invited to submit her name for the final interviews. If she does so, she will automatically go on the shortlist, and if she is found to be the best candidate, she will be nominated by the Commission to this House. The President of the Council was asked—

Sitting Hours

John Mann: What assessment he has made of the impact of his proposals for changes to the sitting hours of the House on hon. Members with school age children living outside the London area.

Stephen Twigg: The main purpose of the proposed changes in sitting hours is to increase the effectiveness of the House of Commons both in legislation and in scrutiny of the Executive. We anticipate that the changes to sitting hours proposed by my right hon. Friend the Leader of the House will benefit all Members with children.

John Mann: It is most laudable that Members of the House who live in London—and indeed civil servants—and have expressed the view that they should be able to spend more time having breakfast with their children will be given the opportunity to do so. I hope that the Leader of the House will give equal consideration to all Members, regardless of where in the United Kingdom they live with their children, and that this does not apply just to those Members who happen to live with their children in London.

Stephen Twigg: My hon. Friend raises an important issue which has been raised by Members on both sides of the House. A number of the other changes proposed by my right hon. Friend would benefit Members with families, such as making permanent the Thursday experiment on hours, having fewer sitting Fridays and having a more predictable annual pattern of sittings.

NHS Hospital Management

Liam Fox: To ask the Secretary of State for Health if he will make a statement about his proposal to allow NHS managers to establish non-profit-making companies to manage hospitals, as outlined in today's edition of The Times.

Alan Milburn: The NHS plan that we published in July 2000 set out how power and resources would be devolved to front-line NHS services. It said:
	"NHS organisations will be rewarded with greater autonomy and national recognition"
	including
	"greater freedom to decide the local organisation of services."
	The proposals for foundation hospitals are rooted in the NHS plan. They come about as a consequence of discussions that we have had with the best performing NHS hospitals. Those hospitals are already beginning to get greater freedom and more resources. For hospitals which are not performing well—the poorest performers—we will consider franchising their management to bring in fresh blood.
	The best performers, however, have now put to us proposals for a change in their structures, not to take them out of the national health service but to have greater freedom to improve care for NHS patients as part and parcel of a modern health service. These proposals clearly draw on precedents in other parts of the public sector such as schools or further education colleges and the growing interest that there has been in recent years in public interest companies and mutuals as an alternative to either purely state-run public or shareholder-led private structures.
	Our three-star hospitals have now asked us to look at whether such models could be applicable to local health services to form foundation hospitals within the health service but run more independently than now. I think it right that we should examine the case that they have made.
	We will consider the applicability of foundations not just to the best hospitals but to the best primary care trusts. Over the next few months we will be working with them to examine the legal, financial, governance and accountability issues.
	While this will only ever be voluntary not mandatory for the health service's best performers, alongside new incentives, more devolution and greater patient choice it will help make for a different sort of NHS: where there is more diversity and less top-down control, with a framework of national standards in place and a means—[Interruption.] The right hon. Member for Bromley and Chislehurst (Mr. Forth) is getting very excited—it is easily done. With a framework of national standards in place and a means of independently inspecting them, there is now the opportunity to set free the best hospitals and the best primary care trusts to improve NHS care for NHS patients.
	Patients will remain NHS patients, treated according to NHS principles, with care that is free and available according to need—not as some Members advocate, according to their ability to pay. Those are the right values for the NHS. It is not NHS values that need to change, but NHS structures.

Liam Fox: Only a few weeks ago we were told by the Prime Minister that we were at the end of the era of spin, but here we are for the second day in a row having to drag a Secretary of State to the House. In The Times this morning, the Secretary of State tells us that it was the most important speech in his time as Health Secretary. If that is true why was that speech not made to the House of Commons? If it is not true, it is indicative that the spin goes on.
	Well, the right hon. Gentleman has the headlines and we rather like those headlines; or in new Labour speak we rather like the direction of the journey—it is in our direction of travel. There is more than a little suspicion that this is yet another example of the Secretary of State, when under pressure, adopting the "Blue Peter",'Here's one I made earlier'" approach to policy, so let us see if we can get some details.
	The Secretary of State wants to give management more freedom—but does he? Management would generally assume that four things were needed to give proper freedom: to be able to borrow from the markets; to set strategy; to set pay and conditions; and to contract for services independently. How many of those will be given in the foundation hospitals?
	In his speech this morning the Secretary of State said, in reference to further education colleges, that buying and selling of assets is one of their freedoms. Will these foundation hospitals be able to buy and sell assets? How many of these hospitals does the Secretary of State intend to see by the time of the next general election? Will they still be subject to the star rating? What if they lose a star? Will they be brought back under central control? If so, how—and what legislation will be required? How much freedom will they have in determining pay and conditions?
	The Secretary of State said in his speech that four functions will be left for the Department of Health: setting strategic direction; the integrity of the whole system through IT and staff training; developing the values of the NHS through education, training and policy development; and securing accountability for funding and performance, including reports to Parliament. There was nothing at all about pay and conditions as one of the functions for the NHS, so perhaps the right hon. Gentleman can enlighten us on that point.
	What will any freedom on pay and conditions mean for the current negotiations under way with GPs and consultants over their contracts, or the 18-month negotiations with the nurses over their pay and career development? What does the Secretary of State mean when he says that we will have to find
	"new ways of money flowing around the system to sharpen incentives to respond to patients"?
	Is that money following the patient, or is that money following the patient? That is exactly what the Secretary of State set out to abolish.
	When it comes to asking for meanings, what exactly did the Secretary of State mean when he said that we need:
	"Customisation wherever it can be made but standardization where it is appropriate."
	What on earth did he mean when he said that we need:
	"Management through hierarchy alongside management through networks?"
	We have not the faintest idea what any of that meant.
	This response has not been thought out; it is a panic response by the Secretary of State to orders from No. 10 to try to regain the agenda on the public services. We have had the Health Bill. We have had the NHS plan. Today we have before us the National Health Service Reform and Health Care Professions Bill and now we have the master plan. We are used to having votes of no confidence in Ministers but not usually by themselves in their own Bill on the same day that they are considering it.
	This is not about the future of the NHS: it is new Labour, new year, new panic, new policy.

Alan Milburn: The hon. Gentleman made five substantive points. As for being dragged to the House, I understand that the House will have an opportunity this afternoon and this evening to discuss NHS reform in copious detail. [Hon. Members: "No."] Tomorrow, on a Liberal-Democrat motion, hon Members will discuss health issues and, on Thursday in Government time, they will have the opportunity to discuss changes to structure and culture in the NHS, when we produce our response to the Kennedy report on the inquiry into events at the Bristol royal infirmary.
	The hon. Gentleman says that he could not understand the speech that I made this morning. If he spent a little more time talking to NHS staff at home, rather than running down the NHS abroad, he might be able to keep up. As for the issues that the hon. Gentleman raises, yes, we have set out today proposals for greater independence for the highest performing hospitals. He asks how many. I said in my statement and, indeed, in my speech that that would be a matter of voluntary discretion. It would depend on the number of hospitals or primary care trusts that wanted to move in that direction.
	The hon. Gentleman always urges on me less day-to-day management, less interference and less centralisation, but he does not seem to like it when it happens. As for the sort of powers, resources and responsibilities that the foundation hospitals and others—the primary care trusts, too—will have, as I said in my statement, we will discuss those issues precisely with the primary care trusts and the hospitals. As for pay and conditions, I believe in a very simple principle: if NHS hospitals that have done really well and are performing the best in the NHS, providing high-quality care to NHS patients, want to give extra rewards and more pay to the staff—whether a porter or a cleaner, let alone a doctor or a nurse—whom they employ, they should be free to do so.
	The hon. Gentleman seemed to allude to the internal market. I shall tell him the difference between these proposals and the internal market. The internal market involved using one club—competition—to try to lever up standards. It did not induce competition, and it certainly did not lever up standards. The difference is that we now have in place a clear framework of national standards, national service frameworks, the National Institute for Clinical Excellence, which evaluates new treatments and new drugs as they come on to the market and into the NHS, and an independent means of inspecting them.
	We want to see high standards everywhere, but we also recognise that the NHS cannot be subject to day-to-day running from Whitehall, as it has been for 50 years; it has to have power, resources and responsibilities located in the hands of doctors, nurses, porters, cooks, cleaners and mangers—the people who actually deliver NHS care to NHS patients. The big divide in British politics is between those of us who say that NHS values should be maintained, but its structures changed and the Conservative party, which says that NHS values must be abandoned and that the people must pay for their treatment.

Frank Dobson: I am reluctant to say what I am about to say or to ask the questions that I am about to ask, but will my right hon. Friend bear it in mind that the fact that some NHS hospitals are outstandingly successful demonstrates that NHS hospitals are capable of doing a first-rate job without their management being franchised to the private sector? Will he also bear in mind the fact that private sector health care managers are unlikely to have appropriate experience, as most private hospitals are small, low-tech and have few, if any, emergency admissions compared with a very large NHS teaching hospital, which probably has more emergency admissions, involving great complexity, than the private sector hospitals' total admissions, and perhaps 1,000 doctors on their staff? Will my right hon. Friend guarantee that absolutely none of those outside managers come from such private sector disasters as Railtrack, Equitable Life, Marconi, or the accountants, auditors or management consultants associated with those private sector disasters?
	Finally, will my right hon. Friend at least give some thought to the fact that the public service ethic managed to maintain the national health service through all the Tory years of underinvestment and malignant policies? In those circumstances, would it not be right to give the public service ethic the opportunity to flourish with the extra resources that are now available?

Michael Fabricant: That was an endorsement, wasn't it?

Alan Milburn: I am glad that the hon. Gentleman is alive and awake for once. [Interruption.] God, Conservative Members are in a tetchy mood today—they really are. I understand why the hon. Member for Woodspring (Dr. Fox) is tetchy; he has been brought back from his inter-railing holiday in Europe. He is bound to be a bit uncomfortable. However, I do not know about the rest of them.
	As far as my right hon. Friend's points are concerned, yes, the NHS has very many outstanding managers. There is absolutely no doubt about that. He has some of them in his area; thankfully, I have some of them in my area, too. It is right that NHS managers should be given opportunities, particularly when they are running high performing NHS organisations that have a track record of success. However, if we have poorly performing NHS organisations, it seems to me highly appropriate that we use the expertise of such managers and garner that for the benefit of other NHS patients.
	However, we must also look more broadly than that. What patients everywhere—and not just those in some places—deserve is the best quality management and the best quality services. I simply do not believe that good quality managers begin and end at the public sector's door. We should consider using high-quality management wherever it exists to improve care for NHS patients.
	On my right hon. Friend's point about Railtrack, he is right. What the Conservatives did when they sold off the rail network was catastrophic. [Interruption.] My right hon. Friend asked about Railtrack. [Interruption.]

Mr. Speaker: Order. There was a request to hear the Secretary of State and we must give him a hearing. [Interruption.] Let me decide whether he is in order.

Alan Milburn: I know that Conservative Members do not want to hear about Railtrack.

Mr. Speaker: I do not want to hear about Railtrack, either. [Laughter.]

Alan Milburn: In relation to my right hon. Friend's question, the fundamental difference between what the Conservatives did with the railway network and what we are proposing is that they sold off lock, stock and barrel public sector assets and sold them to the highest private sector bidder. There is no question whatsoever, under any of these proposals, of selling off NHS assets. What we are doing is franchising the management of NHS organisations that are not performing as well as they should.
	I could not agree more with my right hon. Friend when he says that the public service ethos should be maintained at all costs. I think that the best way of strengthening the public service ethos is to get the investment in, but to make some fundamental reforms too.

Evan Harris: Is not the Secretary of State creating a two-tier system of hospitals? The first is for those hospitals that he judges to be performing well and to which this most centralising of Government claim to be giving independence. The Commission for Health Improvement is being charged with inspecting these hospitals based on performance criteria laid down by him—political hoops that hospitals will be asked to jump through. The commission will have to examine how well they are doing not whether it is worth their time doing that. In providing freedom to pay more to staff in better-off hospitals that are doing well, is not the danger that they will simply recruit staff at the expense of the poorer hospitals that have been even more under-resourced by the Government?
	On the so-called failing hospitals, does the Secretary of State recognise that, by his criteria, hospitals could be judged as failing because they put patients and clinical priority before politics and political targets? They will be judged to be failing if they suffer from the Government- induced crisis of bed blocking due to underfunding of social care and the crisis in the care sector.
	The Secretary of State used a comparison with schools. Does he not recognise that naming and shaming to shift the blame from him creates a crisis in confidence that will worsen staff retention in the health service? If it comes to bad managers being removed, he need look no further than himself as the worst manager of a centralising Government who try to micromanage the whole health service.

Alan Milburn: Thanks for the glowing endorsement. The hon. Gentleman raised, I think, only one substantive issue—who would determine the ratings of individual hospitals. He could have mentioned primary care trusts, too. That will be a matter not for Ministers, but for the independent Commission for Health Improvement. No doubt he will have an opportunity to raise those issues this afternoon, either on Report or Third Reading of the National Health Service Reform and Health Care Professions Bill.
	On paying staff the same, I do not know about the hon. Gentleman, but I spend part of my week in the north-east of England and more than half of it in the south-east, and I have noticed a big difference between the two. I do not know whether the hon. Gentleman has also noticed it, but house prices are different, the labour market is different and, by and large, there is full employment down here. To argue that somehow or other we should simply pay everyone the same regardless of the labour market conditions is absurd.
	The hon. Gentleman knows that trusts in his area are rightly paying staff more in order to recruit doctors, nurses and other staff. He seems to be arguing for a uniformity that we have not seen for many years in the national health service, but all that would do is plunge NHS trusts in many parts of the country into growing, not diminishing, problems of recruiting and retaining staff.

Julie Kirkbride: May I give a broad welcome to the Secretary of State's comments? May I also congratulate him on finally understanding that if we are to have a health service fit for the 21st century, the old Stalinist structures have to be dismantled?
	We can understand why the right hon. Gentleman did not want to come to the House today, given the grim faces of Labour Back Benchers. Will he spread a little more happiness by telling us whether, in the negotiations that he intends to have with health service managers and workers and the private sector, he will also consult the health service trade unions on his proposals to end national pay bargaining?

Alan Milburn: I do not think that the hon. Lady is up to date. We have been negotiating with trade unions, as the hon. Member for Woodspring said, for the past two years on a new national framework for pay and conditions in the NHS which would also allow for local flexibility. The hon. Lady called the NHS "Stalinist"—

Simon Burns: No, she did not.

Alan Milburn: She did; Conservative Front-Bench spokesmen were not listening to their Back-Bench colleague. That is precisely what the hon. Lady said. It seems to me that the Conservative party is becoming more like a modern-day Trotskyist sect. Condemning everything it does not like, including the NHS, is Stalinist.

David Hinchliffe: As a moderniser, I welcome the idea of devolving decision making nearer to the patient. My concern with the Secretary of State's proposals relates to the clear parallels that can be drawn with what the Conservative Government announced in the early 1980s in terms of the introduction of the internal market and the consequences of that, and the introduction of private sector management. Some of us suffered from private sector managers in our localities. Bearing in mind the concordat that establishes the relationship with the private sector and what the Secretary of State proposes for management, can he tell those of us who have anxieties about the direction that the Government are taking whether any limits will be placed on the involvement of the private sector in the NHS under the Government?

Alan Milburn: I know that my hon. Friend has a well-deserved reputation as a Labour moderniser on such matters. I agree that devolved decision making is the way forward. The right combination of national standards needs to be in place. However, we have to accept that none of us as Ministers delivers one iota of care. The care is delivered outside Parliament by doctors, nurses, therapists, cleaners, cooks, porters, managers and other staff. We surely need resources and power to be located in their hands rather than ours.
	There is a fundamental difference between the situation that my hon. Friend describes in the early 1990s and now. It is worth remembering how far we have come in just four years. When we got into office there were no national standards, no means of inspecting standards, no means of levering in good practice to replace bad and no means of evaluating new drugs and treatments when they came on to the market. For the first time, we have national standards and independent inspection, and it is right and proper that within that framework the NHS should improve services for patients.
	The crucial limit to private sector involvement is the fact that, as I said in my opening statement, I profoundly believe, as I know my hon. Friend does, in an NHS that provides care according to the right principles, the right values and the right ethos. I believe that care should be available according to the scale of people's needs, not the size of their wallets. That is the position on the Labour Benches; I am not sure that the same is true on the Opposition Benches.

Glenda Jackson: As another moderniser, may I ask my right hon. Friend whether he agrees that delivering high-quality services to patients is, in the main, dependent on a well skilled and highly trained work force? If managers are brought in from the private sector, how will he guarantee that they do not replicate the activities of their colleagues in the wider world who have, in the main, turned their backs on in-house training and simply meet their staffing needs by poaching from others?

Alan Milburn: I do not think that we should try to kid ourselves. In the public sector there are good managers and, sadly, some pretty poor ones, just as there are good and bad managers in the private sector. The best managers, whether they are in the public or the private sector, recognise that if they are to provide improved services to customers or, in this case, to patients, they must invest in their staff and make sure that there are more staff and that they are skilled. That is what I expect to see in all parts of the public services, and it is certainly what we need in the NHS.

Julian Brazier: In between all the new plans, initiatives and restructuring, can the Secretary of State find the time to visit the Kent and Canterbury hospital? I understand that last Friday, just before my arrival at the accident and emergency unit, the hospital had squirrelled away most of the people waiting on beds in corridors. Eighteen remained, some of whom had very serious conditions and some of whom had been there for over 24 hours. That is totally unsuitable care. Ten consultants appeared, at a few hours' notice, to say that the crisis in capacity cannot go on. When will the Secretary of State take action on the crisis in acute health care in east Kent?

Alan Milburn: The hon. Gentleman talks about a crisis in capacity, but he really must have a word with his Front-Bench colleagues because the way to solve the crisis in capacity is to invest. That is what we are committed to doing, and it is a shame that the Opposition are not.

Lynne Jones: I agree with my right hon. Friend that the NHS is too big to be managed from Whitehall and that it should have access to the best expertise. What concerns me is accountability. There are two ways of getting accountability. The first is through competition, but genuine competition requires a surplus of provision, so that patients can choose who provides their service. Even if that were possible in the NHS, surely it is not desirable purely because of considerations of efficiency and expense. The second way to get accountability is through elected representatives, but sadly it seems that that is not an option, as is demonstrated by the National Health Service Reform and Health Care Professions Bill, which we will be considering later today. What will my right hon. Friend do about the accountability deficit in the NHS?

Alan Milburn: On the first point, my hon. Friend is right to say that the only way to expand informed choices for patients is to increase capacity in the NHS. As she is aware, from July this year we will be able, for the first time, to give direct choice to NHS patients. Those who have been waiting six months for heart surgery will be offered the choice of continuing to wait, probably longer, for treatment at their local hospital or, provided that it is clinically appropriate, travelling further to get treatment elsewhere. That will not only increase public confidence in the NHS but drive change and provide incentives for hospitals to treat more patients to higher standards. As for issues of governance, my hon. Friend is right that NHS trusts have quite wide-ranging powers of autonomy, but they are constrained by the current governance structures. Effectively, we appoint five non-executive directors and blithely assume that that is representative of the community's interests. Like my hon. Friend, I believe that that is not necessarily so. We shall want to discuss with the best performing hospitals and primary care trusts whether we can change the accountability structures for the best performers to strengthen the relationship between local health services and the local communities that they serve.

John Redwood: Will the Secretary of State confirm that under his interesting scheme some NHS hospital trusts will be able to buy and sell assets on their own account without seeking Government permission and will be able to borrow money against those assets without needing Government guarantees or permission? Is that the position?

Alan Milburn: As for buying and selling assets, NHS trusts can currently do so. However, under the current regime, which, I recall, was initiated under the right hon. Gentleman's Government and which we have continued, an NHS trust that sells assets of spare land, for example, is not allowed to keep the proceeds for itself. We should consider a different regime for the best performing hospitals; if those that have spare capacity, land and assets want to sell them, they should get the proceeds.

Julia Drown: Can the Secretary of State assure the House that discussion of organisation and reorganisation in that fashion will not divert attention from the key task of delivering the NHS plan? To that end, can he assure the House that he will debate those issues with the NHS modernisation board and patient groups which, I understand, have not discussed or floated them to date?
	Will my right hon. Friend also explain to the House the difference between franchising management and dealing properly with NHS management? There are procedures to deal with managers who do not perform; I hope that the House agrees that that minority should be properly dealt with and disciplined if necessary. How does my right hon. Friend envisage managing trusts in which, say, 80 per cent. of the managers are good but 20 per cent. are bad? At what point should the whole lot be franchised out, thereby losing some very good NHS managers along the way?

Alan Milburn: As I have said, I agree with my hon. Friends that the NHS has some very good managers; I know that it is unfashionable to say so, but that is what I believe. We have some outstanding managers who do a difficult job in extremely difficult circumstances; they manage large, complex organisations and, as we can see from some of the best performing hospitals and primary care trusts, they do so admirably. However, I am afraid that, as in any public service, there are always some that are good, some that are indifferent and sadly, some that are just not up to scratch; I do not think that we should hesitate to say so.
	As my hon. Friend the Member for South Swindon (Ms Drown) will know from her own constituency, it is all too often the case that the poorest services end up being in the poorest communities. We should not sanction that situation; we should have the courage of our conviction and say that where management is not up to scratch, we are prepared to change it. The management, in this case, is the leadership of the organisation; we have chief executives and directors of finance to provide leadership in those organisations. If it is not being provided and services are poor, there have usually been persistent problems with organisation, culture, attitude and so on over a period of many years. We should say that that is not good enough and that we are prepared to change it.

Peter Luff: On the earlier subject of Trotskyism, may I politely remind the Secretary of State that he is the real Trotskyist because he is keeping the national health service in a state of permanent revolution? However, if the Government abolished grant-maintained schools, why are they introducing grant-maintained hospitals?

Alan Milburn: Just as a small historical correction, if my memory serves me right, permanent revolution was more a feature of Maoism than Trotskyism. I am willing to admit that I could be wrong; the hon. Gentleman may be much more of an expert than I am, or was, on that sort of issue. If he cares to look at public services, whether in FE colleges, schools or whatever, he will see that we have a national framework of standards and diversity of provision. That is delivering the goods in improved standards in education, better outcomes for children and so on. We need to apply precisely the same disciplines to the national health service. We have a clear framework of national standards, which my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) was partially responsible for putting in place. We have independent inspection. We have the right ethos, the right values and the right principles. In order to deliver improved services for patients, we must empower the NHS front-line.

Dennis Skinner: What are the special qualities that the private sector seems to have, as opposed to those who have dedicated 50 years to the national health service as a public service?

Alan Milburn: As I said to my hon. Friend the Member for South Swindon a moment ago, we have some outstanding people working in the NHS as managers, and some outstanding hospitals and primary care trusts. However, my hon. Friend the Member for Bolsover (Mr. Skinner) will know from his constituency experience, as I know from mine, that sadly, in local government services and sometimes in the health service, the fact that service providers are located within the public sector does not necessarily mean that they deliver the best of services. I am interested in what the patient gets. NHS patients should get high-quality care. What we should expect to see in all our constituencies in all parts of Britain is the highest quality of care for patients, regardless where the care is provided.

Hywel Williams: What are the implications, if any, of the Secretary of State's proposals for the NHS in Wales and Scotland? In a written question on 26 June, I asked the right hon. Gentleman
	"what discussions he has had with the National Assembly concerning the use of private management in the health service in Wales."—[Official Report, 26 June 2001; Vol. 370, c. 76W.]
	His answer was one word: "None."

Alan Milburn: That remains the position.

Mike O'Brien: I welcome my right hon. Friend's proposals to give greater freedom and power to succeeding managers, but like my hon. Friend the Member for South Swindon (Ms Drown), I am concerned that those ought to be balanced by proposals to make it easier to remove failing managers in the NHS.

Alan Milburn: My hon. Friend is right. In these debates there is always a danger that we assume that every hospital will become a foundation hospital, or that every slightly under-performing NHS trust will lose its top management. That is not the case. We have other means to improve performance in the NHS, such as incentives or an NHS modernisation agency to lever up standards and to spread good practice. We have a wholesale set of reforms coming in, but sure, in the exceptional cases where there is a problem with poorly performing NHS organisations, we should not hesitate to change the management team.

Andrew MacKay: What is the real reason for the Secretary of State not making a statement to the House about a policy initiative that is clearly very significant? Could it be that he realised that there would be considerable support from the Opposition and no ringing endorsement from Labour Members, who look extremely upset?

Alan Milburn: Anyone doing my job is grateful for ringing endorsements from any quarter.

Gareth Thomas: As someone who represents one of Labour's new heartland seats, may I encourage my right hon. Friend to come again and visit Northwick Park hospital, where I could introduce him again to first-class management? Those managers are keen to persuade him of the case for more investment in maternity services to revolutionise the quality of care currently available at Northwick Park's maternity unit. I encourage my right hon. Friend to take no lectures from the Opposition, who axed two thirds of the accident and emergency provision available to my constituents, and whose proposals for new charges for access to GPs seem to strike at the heart of the NHS principles.

Alan Milburn: My hon. Friend is right. This morning I listened with interest to the Opposition spokesman, the hon. Member for North-East Hertfordshire (Mr. Heald), refusing to rule out charges to visit the GP's surgery. [Interruption.] The hon. Member for Woodspring ought to keep an eye on his colleague because that hon. Gentleman was touring the studios—it was on BBC News 24, I think, or it may have been Sky News—and repeating the interview. There is a fundamental difference between the Opposition and the Government. They want to charge; we say that services should be provided free. My hon. Friend is right—the Labour party is building up the national health service, whereas the Conservatives would run it down.

Crispin Blunt: I am intrigued by what the Secretary of State said about the undesirability of micromanaging the health service from Whitehall, given that it was only last month that he pre-empted negotiations between BUPA and the Surrey and Sussex Healthcare trust about the provision of elective surgery at the East Surrey hospital site, which will now be undertaken by BUPA in the old Redwood hospital. Can I now hold on to the hope that, as those elective operations will now be administered and managed by BUPA, there is a possibility that the whole East Surrey hospital could be managed by BUPA, which is a not-for-profit organisation?

Alan Milburn: I would not have thought that that would be the case, but I can say that the negotiations between the health service and BUPA are going very well.

Gordon Prentice: It is not true that my right hon. Friend is a Trotskyist, although he is perhaps a Leninist in terms of policy being decided by the few and not the many. My specific question is this: who decides which assets will be sold? For NHS trusts located in the south-east, where property and land values are very high, there is an invitation to asset-strip.

Alan Milburn: My hon. Friend is completely wrong. If he bothers to look at the star ratings that we produced late last year—I urge him to do so—he will see that there is a clear balance between the north and south in terms of NHS trusts with a three-star rating. We must get away from the idea that, because a trust serves a poor area, it is rather like a school serving a poor area and it can be assumed that it must inevitably have poor standards or organisation. That is simply not the case. It is an important incentive to improve performance for people running the services, whether they are in the north or south or in an NHS trust or primary care trust, that, if they want to make changes to local health services that are to the benefit of NHS patients—we must remember that they will continue to be inspected and annually assessed on their performance—they have the freedom to do so.

David Tredinnick: The right hon. Gentleman said that he would like more diversity in the national health service. Is that comment linked to the briefing that he gave to journalists before Christmas, which suggested that Ministers were calling for herbal cures on the national health service? The story was published in three or four national newspapers. Does it represent a change of policy at the Department? Is the Department now looking for an integrated health care service and is this development a part of that strategy to roll out more availability of different treatments through a new-style national health service with more diversity and more power given to managers?

Alan Milburn: As I have told the hon. Gentleman on very, very, very many occasions, both in Health questions and other health debates—[Interruption.] I have read the headlines, honestly. I say to the hon. Gentleman that he will have a much happier life if he does not believe everything that he reads in the newspapers. I try not to believe everything that appears in the newspapers, because it would drive me completely crazy. On the particular issue that he raised, he knows the position: it is a matter of local discretion in deciding the services that are provided to NHS patients.

Derek Twigg: My right hon. Friend will know about the difficulties that we have recently faced in Merseyside in relation to poor management practices, although he will also know that there is lots of good management practice as well. On that basis, I welcome the move to ensure that we have more devolved powers and that decisions can be taken locally. While massive investment is taking place in the health service, the public expect massive change in the management efficiency. That is why I welcome the proposal to give management power and discretion to local hospitals. On accountability, the PCTs will have the bulk of NHS money to spend in the not-too-distant future. How can he ensure accountability to the PCTs, making sure that those hospitals deliver efficient and good services in the locality?

Alan Milburn: I agree with my hon. Friend. The simple answer is that primary care trusts will hold the budgets, and they will make the decisions, especially when they receive more and more of the NHS budget. By 2004, they will have three quarters of the total budget, and they will determine which services to commission from which provider. I should be surprised if every primary care trust, aided and abetted if possible by the Department, the Modernisation Agency and the Commission for Health Improvement, did not have a clear eye not only on the quality of services but on value for money, including, as my hon. Friend rightly said, the organisation and management of every hospital. Primary care trusts must do that when discharging their functions on the accountability of public money.
	My hon. Friend knows that we publish reference costs every year. They spell out the difference in the cost of treatment between NHS hospitals. I should be surprised if primary care trusts did not increasingly use the reference costs manual as a bit of a Bible for commissioning services. It clearly spells out the differences in efficiency between hospitals. That is at least partly due to differences in efficiency in the management of hospitals.

Martin Smyth: The Secretary of State will know that there are differences between not only areas but management styles. Does he agree that the larger hospitals have an advantage? Time and again, they have gathered more money from the health service but not always performed at the level that they should. That is to the detriment of other hospitals. Has he studied the results of the change of management strategy over the years? We have changed names and paid managers more money, but they have not undertaken the required management. We brought in outside managers, and they did not last the pace. Does he believe that a change of management will transform the health service? He speaks about not-for-profit trusts, but will large trusts continue to exist, eat up the money and rob other parts of the health service of the necessary cash to maintain the required standards?

Alan Milburn: Like the hon. Gentleman, I believe that we all want high-quality management and services in every part of the United Kingdom. There is no doubt that we need to foster a new generation of NHS managers. It is inevitable that there has been a fixation today on poor NHS management, but we should bear it in mind that we have some fine NHS managers. I can give testimony to that. When we provided the star ratings last year and considered the different performance of NHS hospitals, there were three times as many three-star NHS trusts performing at the highest levels as no-star hospitals. Of course, that is fundamentally due to doctors, nurses and other staff, but it is also due to the managerial leadership in those three-star trusts. We should not be frightened of saying that. I agree with the hon. Gentleman that we need better management in all parts of the NHS, and more management when appropriate. Management and leadership hold the key to many of the changes that we need to unlock in local health services.

Henry Bellingham: I thank the Secretary of State for his interesting statement. It has not escaped Conservative Members' attention that his best proposals were lifted from the last Conservative manifesto. Imitation is a form of flattery, but I want to ask a specific question about our local hospital. If it opts out and imposes better pay and conditions for its staff, but is subsequently taken back into mainstream NHS management, what will happen to the pay and conditions? Will they be reversed? Will the pay be docked?

Alan Milburn: I notice that the hon. Gentleman and the Conservative party speak the language of opt-out, while we speak that of one NHS, one set of values, principles and standards, and one inspection. [Interruption.] Since the hon. Gentleman is so keen on private sector organisations, he would do well to examine successful examples. He will find that they are held together by a common ethos, but that they give local autonomy to local services when there is an interface between the service and the local consumer. That happens in the best private sector organisations, and must also happen in the NHS.
	I read the Conservative party manifesto for the last general election; it was devoid of content.

David Taylor: It will be no surprise to the Secretary of State that his announcement will stick in the throats of many Labour Members like an unchewed pretzel. Will he reassure Labour Back Benchers that he is not performing a soft shoe shuffle through the private operation of public assets to their eventual private ownership? Will he reflect on the experience of our antipodean cousins? Private management of public hospitals in Australia has been shown to be fraught with problems and difficulties and has led a Committee of the Australian Parliament to recommend:
	"No further privatisation of public hospitals should occur until a thorough national investigation is conducted and some advantage for patients can be demonstrated for this mode of delivery of services."
	No such advantage has been demonstrated in practice or in the Secretary of State's statement.

Alan Milburn: Nobody is advocating the privatisation of NHS services. I am not; the Government are not; nobody is. Indeed, it is quite the reverse. We want patients everywhere, not just in some places, to get high-quality NHS care according to the right NHS principles: care that is provided free according to need, not to the ability to pay. That is the right set of values. However, I simply do not believe that we can continue with the age-old structures, and assume that a national health service of 1.2 million people treating 20 million patients a year can somehow be run from a single office in Whitehall. That simply will not deliver the goods for patients.

Richard Taylor: I know that the Secretary of State is aware of a recent vote of no confidence in their managers, both at trust and health authority level, by a vast majority of consultants across the whole of Worcestershire. What does he propose to do about that?

Alan Milburn: In keeping with the spirit of devolution, that is a matter for the management in Worcestershire. If the hon. Gentleman is concerned about that issue, he should raise it locally rather than with me.

John Baron: Will the Secretary of State tell the House what criteria will be used to ascertain which hospitals are deemed to be failing, and which will become more autonomous? Will that depend on the star rating system? If so, as hospitals move up and down that rating system, will that signify a change of control?

Alan Milburn: Yes, that will depend on the star ratings. Last year—the first year that we used the star ratings—we used certain criteria. I said at the time that the star ratings were far from perfect and that they needed to be improved—and indeed they do. This year, when we do the star ratings, with the involvement of the Commission for Health Improvement—and in future years with growing CHI involvement—the hon. Gentleman will see that the star ratings give a much more rounded assessment of performance, not only in primary care trusts but in NHS trusts too.

Point of Order

Eric Forth: On a point of order, Mr. Speaker. You know, and we know, that you have recently deprecated the practice of Ministers making important statements outside the House, and then not even volunteering to make them here but having to be dragged here by a private notice question. You reminded us of that very recently. We have now had a blatant example of a senior Minister casually disregarding what you have said from the Chair. Is it now time for you to consider what further action you must take, and whether you might invite Ministers for private meetings—probably without coffee—to discuss this with you? Might you also consider whatever further sanctions may be available to you within the constraints of our Standing Orders and of Erskine May? The House will not put up with this any longer. You have given guidance, and correctly said what must happen, yet here we have another example of arrogant Ministers ignoring the House until they are dragged here.

Mr. Speaker: Order. I do not think that the Minister was dragged here. [Interruption.] Order. No, he was not. A private notice question was submitted, and one of the reasons why I agreed to it was that a statement was made outside the House. So far as Ministers coming to see me is concerned, Ministers and shadow Ministers are more than welcome to come and see me—as, indeed, is any hon. Member—and they will always be able to get a coffee.

Members of Parliament (Employment Disqualification)

Peter Bradley: I beg to move,
	That leave be given to bring in a Bill to regulate the remunerated employment a Member of Parliament may undertake.
	In last week's debate on Lords reform, there was broad political consensus across the Chamber on the need to modernise and extend our democracy, not just in the Lords, but in the Commons, to improve Parliament's scrutiny of the Government and to rebuild public confidence in politicians. If we meant what we said last Thursday, I hope for similar agreement from both sides of the House that this Bill would make a modest but important contribution to the reform of Parliament and the rehabilitation of its Members.
	There has also been much debate recently about the way in which we do our business here. Why does the House of Commons not sit routinely in the mornings? Simply because in Parliament's so-called golden age running the country and holding the Executive to account were not allowed to interfere with Members' principal interests—making money in the City and the law courts. Why do we have such long summer recesses? So that landowning Members of Parliament could go back to their estates to get the harvest in. In short, for many, the House of Commons has traditionally been a hobby, an inheritance, an exercise of power without much troublesome responsibility.
	Times have changed and demands on MPs' time have grown exponentially. In the 1950s, Members of Parliament routinely received 15 to 20 letters a week. That figure is now closer to 300 to 500. Constituents' expectations are justifiably higher. Being an MP is a full-time job—a 24-hour a day job, if we let it be so—but we do not have to be here. We are here by choice. Unlike most people, we do a job that we have chosen to do. We are, or we ought to be, full-time professionals. We are certainly paid as such. Indeed, we are well paid for the job that we do. We earn three to four times the average income of our constituents.
	My analysis of the Register of Members' Interests shows, however, that no less than 24 per cent. of our colleagues are not satisfied with the job that they are doing.

Martin Salter: Name them.

Peter Bradley: I am sorry, but it would be difficult to name 155 Members who think that they can do this job and, in many cases, several others besides. The House of Commons has become the epicentre of the black economy. No self-respecting employer in our constituencies would tolerate the moonlighting in which many Members of the House are engaged. It would not be tolerated in our constituencies; it should not be allowed here. However, a quarter of MPs are evidently too greedy, too bored or too arrogant to devote the time and energy to the job that their constituents pay them to do.
	Those Members have not fallen on such hard times that they are taking in laundry. They are in the City boardrooms and the Inns of Court, earning a small fortune. I am not suggesting that MPs should be required to clock on or that the Bill would stop them sending their apologies to Select Committees from the grouse moors—I had that experience as a member of the Public Administration Committee—but we can stop Members moonlighting. That is what the Bill would do. It is not about setting limits on MPs' incomes.
	If hon. Members receive dividends or inheritances, good luck to them, but the Bill would ensure that Members are not paid to be somewhere else when they should be doing the job of MP. It is not unduly prescriptive either. It would allow such occupations—journalism, lecturing, public policy development—that are broadly compatible with the role of MP. It simply is not acceptable for MPs to pursue parallel careers as company directors, Queen's counsel or consultants. The Bill would outlaw those activities for MPs and in so doing help to improve the overall performance of Parliament and its scrutiny role in particular.
	My review of the register has revealed that 8 per cent. of Labour MPs would fall foul of the Bill—that is 8 per cent. too many in my view—and that 28 per cent. of Liberal Democrat Members are moonlighting. It is hardly surprising, but the Conservatives carry off the prize and, indeed, the cheques. In recent years, the Conservative party's persistent theme has been that the House of Commons is supine, Parliament is in decline and the Government go unchecked. Why, then, do Conservative Members have the lowest voting records and the lowest attendance records at Select Committees, Bill Committees and statutory instruments Committees? Where are they?
	According to my analysis, 66 per cent. of Conservative Members—more than 100—are out there in the marketplace when they should be putting their money where their mouth is and holding the Executive to account. When 57 per cent. of Tory Front Benchers and 48 per cent.—almost half—of the Shadow Cabinet are out there, too, it is little wonder that the Opposition are so roundly dismissed and despised by the public. How can a Tory Front Bencher be doing his job when he has 16 directorships to nurture? How can a Tory Select Committee Chairman find time for that important job when he is the director of eight companies, a partner in another, an adviser to two more and a practising barrister to boot?
	The Bill would offer those Members and, indeed, right hon. and hon. Members from all parties a choice—be a member of the board or be a Member of Parliament, but not both. Most Members of Parliament are here because they believe in public service. We need to show our constituents that that is our top priority, first and last. If we cannot commit ourselves to our constituents and keep the faith with them, how can we expect them to place their confidence with us? Reform starts here, and it starts with us.

Michael Fabricant: I oppose the Bill. At the outset, I should make it clear that I have nothing to declare, in the sense that I would not fall within the ambit of the Bill because I do not have the sort of outside interest that the hon. Member for The Wrekin (Peter Bradley) has described. Incidentally, I hope that the hon. Gentleman contacted the Chairman of the Select Committee to whom he referred to say that he would be impugning his integrity.
	I listened to the hon. Gentleman with growing incredulity. He mentioned hon. Members flirting with the boardrooms and the courtrooms. I remind him that many Labour Members who are involved with the boardroom and the courtroom are the most active in cross-examining the Government. No consideration is given in the Bill to the type of work or the amount of time it takes up. It is a catch-all Bill that has nothing to do with the workings of the House, but everything to do with old-fashioned class warfare. Even now, hon. Members are frightened to raise issues of which they have intimate knowledge because current rules say that if Members have an interest, they cannot say anything—even if they know that legislation, for example, is wrong—because it is against the Standing Orders of the House. That is wrong.
	The electorate would be wholly disadvantaged by the Bill. The only winners would be Whitehall or Downing street, because it would result in an emasculated Parliament. I note that the hon. Member for The Wrekin has listed some of the activities that would be exempt under the Bill. I have checked the Register of Members' Interests and that list appears to coincide almost precisely with his own declaration of activities.
	I was also curious to find out why the hon. Gentleman wished to promote this Bill, so I researched his background. He did a BA in American studies at Sussex university. That is not bad, because I did a masters degree at Sussex university. The hon. Gentleman went on to become a public affairs consultant, a research director for the Centre for Contemporary Studies, a director of Good Relations and managing director of Millbank Consultants. So he has never done a proper job.
	I decided to analyse the questions asked of the Prime Minister by those hon. Members who have time to spend—the sort of Member that the hon. Gentleman would like to see in the House. For example, the hon. Member for Hastings and Rye (Mr. Foster) asked:
	"It was great to see my right hon. Friend in Afghanistan earlier this week . . . encouraging our brave troops".—[Official Report, 9 January 2002; Vol. 377, c. 543.]
	That was a question, apparently.
	Just before Christmas, an hon. Lady asked this:
	"My right hon. Friend the Prime Minister will know that the Reading urban area has received an excellent local transport settlement of nearly £7 million and that it has also received £38 million for improvements to junction 11 on the M4. Does he agree—"
	we have a question at least—
	"that this is a wonderful Christmas present for the people of Reading".
	That is an example of incisive questioning. What was the Prime Minister's answer to this difficult question?
	"I agree—I think it is a wonderful Christmas present".
	On the same day, the hon. Member for Caerphilly (Mr. David) asked a penetrating question, bearing in mind that thousands of people had been made redundant in the aircraft industry. Nevertheless, he said:
	"I congratulate the Prime Minister on the Government's effective response to the difficulties in the aerospace industry after the events of 11 September."—[Official Report, 19 December 2001; Vol. 377, c. 280-87.]
	On 21 November, the hon. Member for Doncaster, North (Mr. Hughes) asked this:
	"After his no doubt healthy breakfast, did the Prime Minister have a chance to read the leader in The Guardian? Does he agree that affordable designer casualwear should be available in supermarkets throughout the country?"—[Official Report, 21 November 2001; Vol. 375, c. 312.]
	My final quote comes from the hon. Member for Conwy (Mrs. Williams); I will not be too rude about her because she lives in the same block of flats as me and we often walk home together. On 14 November, she said:
	"Now that my right hon. Friend and his colleagues are sorting out Railtrack—"—[Official Report, 14 November 2001; Vol. 374, c. 858.]
	Need I go on any further, Madam Deputy Speaker?
	The Bill is a load of self-indulgent, unreconstructed, ill-thought-out tosh. It would weaken Parliament, not strengthen it. It may not be consigned to the dustbin today, but I have no doubt that the Labour Government will consign it to the dustbin and dump it tomorrow.
	Question put, pursuant to Standing Order No. 23 (Motions for leave to bring in Bills and nomination of Select Committees at commencement of public business, and agreed to.
	Bill ordered to be brought in by Mr. Peter Bradley, Ms Karen Buck, Mr. Iain Coleman, John Cryer, Mr. David Drew, Ms Julia Drown, Clive Efford, Helen Jackson, Martin Linton, Mr. Martin Salter, Mr. Jonathan Shaw and David Wright.

Members of Parliament (Employment Disqualification)

Mr. Peter Bradley accordingly presented a Bill to regulate the remunerated employment a Member of Parliament may undertake: And the same was read the First time; and ordered to be read a Second time on Friday 19 April, and to be printed [Bill 81].

Orders of the Day
	 — 
	National Health Service Reform and Health Care Professions Bill

As amended in the Standing Committee, considered.

New Clause 1
	 — 
	Readiness of Primary Care Groups and Trusts

'(1) The Health Service Commissioners shall investigate the preparedness—
	(a) of Primary Care Groups to become Primary Care Trusts; and
	(b) of Primary Care Trusts to receive functions in accordance with this Act.
	(2) If after conducting an investigation it appears to a Commissioner that—
	(a) a Primary Care Group is not ready to become a Primary Care Trust; or
	(b) a Primary Care Trust is not ready to receive functions in accordance with this Act
	he shall lay before each House of Parliament a special report.
	(3) If a special report is laid in accordance with subsection (2)(a) above, no action shall be taken by the Secretary of State pursuant to section 16A(1) or (1A) of the 1977 Act for the period of one year from the date of laying of the report. amdtpar(4) If a special report is laid in accordance with subsection (2)(b) above, no functions shall be transferred or distributed to the Primary Care Trust referred to in the report for a period of one year from the date of laying of the report.'.—[Mr. Burns.]
	Brought up, and read the First time.

Simon Burns: I beg to move, That the clause be read a Second time.

Madam Deputy Speaker: With this it will be convenient to discuss the following amendments: No. 6, in clause 1, page 2, line 11, at end insert—
	'(c) a Strategic Health Authority shall only be established under paragraph (a) above provided that there has been consultation with health professionals, local authorities and the general public in that area.'.
	No. 7, line 11, at end insert—
	'(d) a Health Authority shall only be established under paragraph (b) above provided that there has been consultation with health professionals, local authorities and the general public in that area'.
	Government amendments Nos. 23 and amendment (a) thereto, 24 to 26, 74, 27 and 28.
	No. 8, in clause 8, page 9, line 21, at end insert—
	'(2A) In determining the amount to be allotted to a Primary Care Trust, the Secretary of State shall have regard to any liabilities which have been conferred upon it'.
	No. 9, line 21, at end insert—
	'(2B) In determining the amount to be allotted to a Primary Care Trust, the Secretary of State shall have regard to the health needs of the population served by that Trust.'.
	Government amendments Nos. 35, 36, 54, 55 and 61.

Simon Burns: We tabled new clause 1 because, as we said on Second Reading and in Committee, we believe that there has been an inordinate rush to establish strategic health authorities and primary care trusts. It would be a grave mistake, and the height of folly, to rush through reforms in such as way as to leave them half cocked and half baked, so that the Bill does not achieve the Government's aims.
	The changes proposed in clauses 1 and 2 are extremely far reaching. Clause 1 proposes to abolish health authorities in England, of which there are approximately 95, and to replace them with strategic health authorities. There will be far fewer strategic health authorities than there are health authorities, and they will perform the key performance management role across the national health service in England. They will be responsible also for providing a lead in the strategic development of services, and for ensuring that all parts of the NHS work together effectively.
	The new primary care trusts will have the critical responsibility of providing and funding health care. About 75 per cent. of NHS funding will be handed to the PCTs to provide health care for our constituents around the country. The concern is that there has been far too much of a rush over starting up a new system that is very complex and wide ranging.
	I cannot understand why the Government are in such a rush to engineer the reforms. I question whether the structures to be put in place are ready to work without the whole edifice collapsing in confusion and disaster. The Government's rush to implement the changes reminds me of the adage, "Reform in haste, repent at leisure." The British Medical Association has warned that PCTs, where they exist, are relatively new organisations and that, as a result, the demands placed on them may be beyond their capabilities.
	The BMA has highlighted the fact that existing PCTs already experience difficulties in recruiting clinical staff, and warns that those problems will be exacerbated. It is also concerned that the timetable within which PCTs are intended to be and up and running is far too ambitions.
	As we heard on Second Reading and again in Committee, the Standing Committee considering the Health Bill in 1999—which became the Act that made possible the establishment of PCTs—was told by the former Minister of State at the Department of Health, who is now Minister for Police, Courts and Drugs, the right hon. Member for Southampton, Itchen (Mr. Denham), that it was important to emphasise that the Government did not
	"intend a headlong rush to be made into PCTs".
	He added that it was
	"not part of the Government's agenda to impose PCTs on the national health service."—[Official Report, Standing Committee A, 27 April 1999; c. 252-53.]
	In another place, the former Health Minister Baroness Hayman made exactly the same point and gave the same assurances that there would be no rush to create PCTs, but the Government have performed a complete U-turn and are now doing precisely what they said they would not do when the 1999 Act went through this House a mere two and a half years ago.
	Not only Conservative Members are worried. Severe concerns have been expressed by members of the health professions that the proposals are being rushed through. A recent survey in the Health Service Journal showed that 46 per cent. of chief executives in NHS organisations believed that PCTs would be unable to cope with enlarged responsibilities, and that 33 per cent. of them thought that the time scale and scale of the changes were unrealistic and dangerous. One chief executive has called the reforms a recipe for disaster, and another has described them as the most ill conceived and poorly thought out set of changes in decades.
	The King's Fund, in collaboration with the National Primary Care Research and Development Centre, has carried out a tracking survey on primary care groups and trusts. It suggests that there are many doubts about the ability of PCTs to absorb the pace of reform. Professor David Wilkin, the project director, said that the pace of change was being dictated by Government timetables rather than by a process of learning and of building on experience. He also pointed out:
	"It is not merely a question of resources to sort out this issue . . . What is needed are managers with the right skills and experience coming through the system. Managers from trusts and health authorities can be taken on, but we are dealing with primary care and they don't necessarily have the skills needed".
	The survey pointed out that the average number of managerial, financial and administrative staff employed by primary care groups was 6.8, compared with an average number for primary care trusts of 15.8—a serious discrepancy.
	Equally worrying is the fact that one in seven PCGs or PCTs still has—or had at the end of last year—no financial director.

John Hutton: I am reluctant to interrupt the hon. Gentleman's measured flow, but he is aware, because he raised the same point in Committee, that primary care groups are sub-committees of health authorities and are under no obligation to employ their own finance director. They use the finance directors employed by health authorities, which is a perfectly sensible arrangement.

Simon Burns: I appreciate what the Minister says, but PCTs will have to employ finance directors when health authorities are scrapped. It is by no means certain that the finance director of a health authority will become the finance director of a PCT. [Interruption.] The Minister says "obviously". I accept his observation, but I argue that it adds to the force of my case. I suspect that many PCTs around the country will have finance directors without direct experience of working in the health service, with all the nuances and differences that those responsibilities cover.
	According to the report, the situation with regard to information management and technology was perhaps of more concern. It states:
	"Information to support core functions of PCG/Ts is inadequate and shows little sign of improving. PCG/Ts have made some progress in formulating development plans".
	It goes on to say:
	"Increasing shortages of skilled staff and resources make it doubtful whether they will achieve key national targets."
	Of greater worry to the authors of the report, to the BMA and to many others is whether the changes in the Bill will divert activity and resources from front-line patient care. Three quarters of chief executives questioned believed that the reorganisation would delay delivery of the national plan, and a quarter thought that the delay would be severe. That would obviously have a critical impact on the delivery of patient care and the ability to provide the seamless flow of patient care when the changeover occurs.
	Our new clause seeks to save the Government from themselves by laying down procedures to ensure that changes to the delivery of health care under clause, 1 and especially clause 2, are introduced smoothly, successfully and without undue haste. We propose that the health service commissioners should investigate the preparedness of PCGs to become PCTs and the preparedness of existing PCTs to fulfil the functions that the Bill places on them.
	Under our new clause, where it is found that a PCG is not ready to become a PCT or—possibly more important because of the unseemly rush of PCGs to become PCTs—where it is found that a primary care trust is not ready to carry out its functions, a special report would be laid before both Houses of Parliament. There would then be a period of 12 months when no action was taken, so as to establish a breathing space to allow PCGs and PCTs to prepare themselves adequately to perform their duties and functions. I hope that the House agrees that our suggestion is eminently sensible and that it will avoid the confusion and chaos that will result from fragile new bodies carrying out immense new duties with too little or no experience.
	If our Committee debates are anything to go by, Ministers will respond in an ostrich-like way. They will refuse to remove their heads from the sand and will try to reassure us that everything is proceeding satisfactorily, that there is nothing to worry about and that there are no problems. I am sure that they will trot out the same statistics as we heard in Committee at the back end of last year.
	Ministers will tell us that by October 2002 PCT coverage in England will be 100 per cent. I was interested to note, when I re-read the Minister's comments, that during the early sittings of the Committee he told us that there would be 100 per cent. coverage by April 2002. During a few sittings of the Committee, that date seemed to slip back to October 2002.
	Today, the Minister may be able to update us on the statistics that he gave us in Committee on the current progress of PCGs and PCTs. I suspect that, given the relatively short period that has elapsed since the end of the Committee proceedings, the figures will differ little from those that he gave us on 27 November last year.
	The Minister seems rather cheerful, as though there had been a dramatic change in the statistics. I shall read the statistics that he gave us last November, and no doubt he will be able to update us during the debate. While he is doing so he may prove one of the points that I am making about the moral pressure that is being put on PCGs to seek PCT status. They feel under pressure to achieve that status as quickly as possible so as not to miss out, or to cause problems, before October of this year.
	Unless the Minister has startling new figures, however, I suspect that we shall hear that 164 PCTs were established by April 2001; that a further 23 were—at the end of last November—likely to be approved shortly; that 23 of the remaining PCGs were approved for establishment from April 2002; and that 20 had been approved but had not yet received their notification of approval. I suspect that notwithstanding the Christmas post they will almost certainly have received that notification by now.
	The Minister will tell us that 98 PCGs have submitted proposals for approval and were likely to be approved during December 2001 and January 2002. Of course, it is highly unlikely, given the Government's policy, that a PCG will not receive approval for trust status. He will tell us that a mere 11 PCGs are still consulting.
	In the not too distant future the Minister will, no doubt, update the figures. From the look on his face, he may even be able to tell us that he anticipates 100 per cent. approval by April 2002. That remains to be seen. However, behind all those statistics and behind whatever new statistics the Minister may shortly give us, a simple fact remains: there has been undue haste because the Government have changed their policy on PCTs. In effect, they have moved from a policy that was wholly voluntary.
	The Minister will say that there is currently no legal power to make any group become a PCT. That is true, but the pressure on PCGs to fall in line with the Government's policy and become PCTs is overwhelming, because they know that once the Bill is on the statute book the voluntary nature of becoming a PCT will be removed. We questioned the Minister on several occasions in Committee. He replied that he would ensure 100 per cent. coverage of PCTs in England by October 2002—if necessary, by using the legislation.
	PCGs are now becoming PCTs voluntarily, but that masks the pressure they have been under—that of knowing what the future holds for them. Like all hon. Members in the Chamber, they have seen the Bill and know the Government's intentions. As a result of that pressure, many PCGs that were not in the first wave rushed into securing trust status, which they otherwise probably would not have sought within such a relatively short time scale. A great deal of pressure has been put on PCGs to achieve PCT status, and many of them might not be properly prepared to handle their new, highly complex and difficult responsibilities. For those reasons, tremendous problems could arise in the health care provided to our constituents.
	My message to the Government is simple, and it is intended to be helpful: they are under no pressure—or only that caused by their own enthusiasm to put their Bill on the statute book to ensure that their proposals are up and running as soon as possible—and they should hold back for a short period. I suggest not that the proposals on trust status should be kicked into the long grass for a decade and a day never to happen, but that the Government should allow a little more time for the experience and expertise to be built up to ensure that, from day one, PCTs operate in a seamless and workable way and that our constituents encounter no hiatus, no teething problems and no other problem with their health care.
	As my hon. Friend the Member for North-East Hertfordshire (Mr. Heald) said in Committee, we do not disapprove of the PCT concept, but we want the Government to ensure that PCTs work properly and that they seamlessly fulfil their functions as soon as possible. If something is rushed, there can be no guarantee that that will be the end result. I warn Ministers now that if the transition is not seamless and it is bungled by the rush, terrible problems will arise. People's health will be directly affected by any hiatus in the supply of care. Ministers do not want that to happen, which is why I cannot fully understand why they seem to be reluctant to take well-meaning advice simply to delay things a little to give the system time.

Lynne Jones: I understand the hon. Gentleman's concern about the rush to create PCTs. I attended a meeting of the PCG in my area last summer and can confirm that pressure has been put on those organisations. Indeed, a PCT has been created in my area despite the fact that the majority of GPs voted against it. However, I am not so sure about the new clause. There should be a delay but, when the health authorities are abolished, who will carry out the responsibilities currently delegated to PCTs?

Simon Burns: The hon. Lady, who represents a Birmingham constituency, alludes to a considerable problem with primary care trust status in her area. There was a great deal of opposition to the proposal. As she knows, there could be serious problems if—God forbid it does not happen—there were to be a hiatus as a result of the change. As she rightly said, the health authorities that handle the funding for the provision of services will be abolished and replaced by smaller strategic health authorities that have a completely different function and role.
	Most of the functions that health authorities perform will be transferred to primary care trusts. If they are in turmoil as a result of their lack of experience of running the new system, they will face a serious problem and there will be no way out of it. That is why I am desperately trying to impress on the Minister how sensible it would be to provide a little more time. We should not push the policy into the long grass never to be seen again; we should provide more time to allow expertise to be built up.

Mark Francois: I want to support my hon. Friend's argument with a practical example from my constituency. Rochford primary care group, which includes several GP practices from Castle Point, considered whether to apply for PCT status but declined to do so in the first instance for a number of reasons. It had general concerns about the Government's proposals, faced some organisational issues and also faced problems with timing. Some of the GPs who were consulted thought that they were being rushed into the change.
	My hon. Friend's point is a real one, as evidenced by experience in my constituency. Leaving aside GPs' anxieties about the overall desirability of the proposals, many are anxious about the pace at which the change is being attempted.

Simon Burns: I am grateful to my hon. Friend and next-door neighbour for a powerful point that backs up the examples that my hon. Friend the Member for North-East Hertfordshire and I have been given from around the country.
	My hon. Friend the Member for Rayleigh (Mr. Francois) is absolutely right. He has first-hand experience in his constituency of a problem that is not unique to his area. I am glad that the Minister is here to listen to the very problems that my hon. Friend highlighted.
	Amendments Nos. 6 and 7 would also affect PCTs, as strategic health authorities in England and health authorities in Wales would be created only once there had been proper consultations
	"with health professionals, local authorities and the general public"
	in the relevant areas in which the authorities are to be established.
	I hope that Ministers in a Government who pay lip service to openness will find the amendments appealing. Before establishing a body that is responsible for strategic planning, it would be sensible that those who have to help to implement decisions and those who will be affected by those decisions should be consulted about the setting up of the authorities and about the crucial strategic role that they will play.
	I am heartened and pleased that we tabled such timely amendments. I received on my desk at lunchtime the Secretary of State's speech to the New Health Network, which he gave this morning. I am not sure when you entered the Chamber, Madam Deputy Speaker, but it was interesting to see the Secretary of State for Health dragged here at half-past 3 to respond to a private notice question from my hon. Friend the Member for Woodspring (Dr. Fox). The right hon. Gentleman's interesting and important speech raised a number of issues on which we, through the good offices of Mr. Speaker, had the opportunity to question him, instead of leaving it to journalists.
	It was fascinating to see the right hon. Gentleman's reaction. The Benches were much fuller, and we had to look far and wide to find a Labour Back Bencher who was prepared to offer a crumb of support for the contents of his speech. It struck me that if the speech sets out his new philosophy and ethos—the word that he now uses—perhaps his Minister of State will be more amenable to accepting amendments Nos. 6 and 7, which encourage openness and consultation.
	In the speech to the New Health Network, the Secretary of State said:
	"All of these reforms"—
	although relevant to the health service more generally, they tie in with the amendments—
	"involve government acting on behalf of patients in order to influence how the NHS relates to patients",
	as, indeed, the strategic health authorities should relate to patients. He went on:
	"They are all about getting the NHS to put the needs of its patients first. But a service designed around the needs of patients has to hand over more power directly to them. So there are reforms to give patients a greater role and a stronger say in the NHS—patients forums in every trust"—
	we will get on to those later because my hon. Friends and one or two Labour Members are not fooled by that—
	"patients electing patients onto trust boards, the results of patient surveys helping to determine the ratings and the resources that trusts receive. And there are reforms too to introduce new procedures for informed consent because while patients have a responsibility to keep healthy, treat professionals respectfully and use services wisely, they have a right to be involved in decisions about their own care."
	I welcome the Secretary of State's philosophy on that, but what gives patients a greater opportunity to be involved in decisions about their care than consulting them, with health professionals and local authorities, as part of the local community, before the important strategic health authorities are set up? I should have thought that he would be delighted that I am embracing that aspect of his philosophy.
	Although the Secretary of State had to concentrate on surviving the questions put by Labour Members this afternoon and possibly has to brace himself for the publicity that he will receive from the national press tomorrow morning and on the airwaves tonight, I hope that he will find a little time to win back some of his lost ground by contacting his Minister of State, whose presence in the Chamber means that he is isolated from him, to explain that the amendments provide a way to involve patients in the process and enable us to do something constructive, which I have been outlining in a high-falutin' way in my important contribution.

Andrew Murrison: I wonder whether my hon. Friend shares my mystification about where in the Bill there is any reference to the plan that the Secretary of State outlined only a short while ago.

Simon Burns: My hon. Friend raises a rather confusing point. No doubt he was present for the private notice question, so he distinctly heard the Secretary of State say that he had not been dragged to the House today and that we would have the opportunity, during this evening's debate, to discuss the proposals outlined in his remarks. I am not convinced that the Secretary of State is as well acquainted as you are, Madam Deputy Speaker, with the procedures of the House.

Oliver Heald: The Secretary of State has not read the Bill.

Simon Burns: Certainly not. That is left to the Minister of State.
	You, Madam Deputy Speaker, will tell me, rightly, that I cannot discuss the matters on which the Secretary of State was being questioned because they are not in the Bill, but my hon. Friend the Member for Westbury (Dr. Murrison) is right to be mystified. The only part of the Secretary of State's remarks today that is relevant and, more importantly, in order—

Madam Deputy Speaker: Order. The hon. Gentleman is right to say that he should be addressing his remarks to new clause 1.

Simon Burns: I am extremely grateful, Madam Deputy Speaker, because before you correctly reminded me of that, I was about to say that the only remarks by the Secretary of State that are relevant to the Bill relate to the narrow amendments, Nos. 6 and 7, on the need to consult before setting up strategic health authorities.
	I am optimistic that a crumb will fall from the table, as it did in Committee, and the Minister of State will ask, "Why didn't we think of this first?" If the Secretary of State had made his remarks earlier, we could have amended the Bill in Committee. The Minister of State would not have been so hard-nosed in Committee as to oppose our amendments on strategic health authorities. I hope that he will be more relaxed and more amenable to amendments Nos. 6 and 7, which would play an important role in empowering local communities before the establishment of strategic health authorities. They would make communities feel that they were part of the system, and people would be reassured that their opinions, ideas and recommendations were being taken into account.
	Amendment No. 8 is straightforward. It looks modest but it is important, concerning as it does any funding and financial liabilities conferred on a new primary care trust under the new system. It may represent a belt-and-braces approach because I believe that the Minister of State said in Committee that, with one exception, health authorities do not have deficits. He may therefore argue, and I will listen carefully, that the amendment is not needed because when the new system is established, no deficits or liabilities will be conferred on the PCTs. However, this is an important issue that needs to be considered because nobody wants to strangle the new system at birth with debts that the PCTs did not incur.
	Finally, amendment No. 9—again, a straightforward amendment—states:
	"In determining the amount to be allotted to a Primary Care Trust, the Secretary of State shall have regard to the health needs of the population served by that Trust."
	A modest proposal: I assume that few people in the Chamber would disagree with its sentiments. It is important that the funding of health care is based on the needs of the local population and, of course, there are different needs in different parts of the country and among different populations. Off the top of my head, in my own area of mid-Essex there is a pressing need for even more money than the increase because, as the Minister is all too aware, our hospital waiting lists have not fallen for a single day below the level at which they were when the Government came to power on 1 May 1997. I have said before, and have told the Prime Minister, who does not seem to have an answer, that there is a pressing need to take into account local considerations; for some reason, the Government cannot honour their promise to bring down waiting lists in mid-Essex.
	There are other interesting criteria. I am sure that you are an avid reader of Hansard, Madam Deputy Speaker. One should look at the figures; I am choosing my words carefully because, I confess, I made a mistake 10 days ago in a written question. I asked the Government for health spending per head of population in Sedgefield, West Chelmsford, South-West Surrey and North-West Hampshire. Their response surprised me although, in another way, it did not. Funnily enough, Sedgefield receives noticeably more funding per head of population than West Chelmsford, South-West Surrey and North- West Hampshire—but not according to the answer, because, to be fair to the Minister of State, I was not specific and asked only for the amount. He gave me the weighted amount; his answer showed that the four areas, give or take £10 or so, each received about the same.
	If one asks the question that I should have asked—"What is the actual spend?"—the amounts are significantly different. Sedgefield gets significantly more per head of population than the other constituencies. I do not imagine that that was the case 10 years ago and I imagine that, in a few years' time, it will not be so.

Evan Harris: My understanding is that the weighted capitation allocation formula was introduced by the Conservatives as a change from the one used by the old resource allocation working party. It was amended on the advice of the University of York by this Government or the previous Government. Nevertheless, the hon. Gentleman will find that it has always been the case that deprivation, because of greater health needs, rightly leads to greater funding.

Simon Burns: I accept that. I thought that that was what I was saying about the amendment: different circumstances—including social deprivation, but others as well—determine the amount of health spending. We are trying to include that in the Bill; we must have regard to the population's health needs. To be fair, RAWP, for reasons that I shall not go into, was a flawed system, certainly for people in the home counties. My right hon. Friend the Member for South-West Surrey (Virginia Bottomley) changed the system to one that depended more on allocation per head of population. Indeed, when the Secretary of State first came to the Department as a Minister in 1997—

Madam Deputy Speaker: Order. The hon. Gentleman will now get back to the main point in his amendment.

Simon Burns: Thank you, Madam Deputy Speaker.
	When funding allocations are made to PCTs, it is important that the needs of the population served by that trust are taken into account, for health rather than political reasons. On those grounds, I hope that the Minister will accept the amendment. One lives in hope. It is a new year, and the Minister is a reasonable man.
	Finally, I urge the Minister to consider carefully the time scale for the changeover to PCTs. It would be a crying shame if their introduction was marred by the fact that the system did not run smoothly. With the money that will be available, there is potential for PCTs to make a real difference to local people.

Evan Harris: I shall comment briefly on the amendments in the group and speak to my amendment (a) to Government amendment No. 23, before the Minister moves the amendment. The hon. Member for West Chelmsford (Mr. Burns) knows that I share his concerns about the speed of the change being imposed on the health service and the fact that there is to be yet more structural change. There seems to be no coherent strategy emanating from the Government under the Health Act 1999. As the hon. Gentleman said in Committee and repeated today, the national plan did not envisage that all primary care groups would have to become primary care trusts, no matter what.
	As I said on Second Reading and in Committee, part of the motivation for the changes seems to be that the Government want to be seen to be doing something and are therefore substituting activity for action. I expect that the Government will resist the new clause for the same reasons as they have done before.
	Amendments Nos. 6 and 7 may well be covered by provisions in the Bill. Government amendment No. 23 deals with consultation issues. There is little enthusiasm for yet more amendments on that subject, such as amendments Nos. 6 and 7, because of the consultation arrangements already included.
	I recognise that Government amendment No. 23 is a response to concerns raised in Committee by the hon. Member for Leigh (Andy Burnham) and others.

Oliver Heald: The hon. Gentleman should give credit to my hon. Friend the Member for West Chelmsford (Mr. Burns), who spoke to the amendment. The hon. Member for Leigh then agreed.

Evan Harris: I am more than willing to do so. I apologise if the hon. Member for West Chelmsford is deeply offended by not having had due recognition of the fact that he raised concerns about the degree of consultation. We all agree that there should be adequate consultation about strategic health authorities when boundaries and names are changed. I feel so strongly about the matter that I tabled an amendment to Government amendment No. 23, which would specify that the Secretary of State "shall", not simply "may", make regulations. I hope that the hon. Member for West Chelmsford will support that.
	Under previous arrangements, when there were community health councils, there was a duty on the Secretary of State to consult on such changes. That duty had existed for 23 years, since the National Health Service Act 1977. It seems that the obligation to consult—that is, the Secretary of State's duty to make regulations—has not exactly fettered Governments in reforming names, structures or boundaries since then. We have been inundated with reforms over those 23 years. If the Government choose to resist amendment (a) to Government amendment No. 23, they must explain why they place a lower priority on consultation than in the past, making it a mere optional extra if the whim takes the Secretary of State.
	The question is whether the Government will empower local communities by asking them what they think. I had a useful meeting with the Under-Secretary of State which touched on the matter. She kindly responded by letter, and I hope she will not mind if I quote it. She stated:
	"The Government amendment specifies that the Secretary of State may make regulations, rather than shall."
	She said that the reason for that was:
	"ensuring that there is scope for flexibility in the future."
	The only remaining flexibility relates to the ability not to make regulations on consulting local communities. If the Government want such flexibility, it can only be to water down obligations for which they should be providing. I hope that they will reconsider the wording of Government amendment No. 23. If they resist amendment (a) thereto, we will have to raise the matter in the House of Lords.
	As I said in an intervention, I am not entirely sure of the purpose of amendment No. 9, or of what it would produce. I understand that allocations that are part of weighted capitation are sensitive to the health needs of the local community. My concern is that the Government often go too far in seeking to take parts of that cake for central allocation, which inevitably does not ensure that allocation is transparent. The formula is complex, but at least we know what we are dealing with and allocations move slowly towards that formula when there is growth in the system.
	I look forward to hearing the Government's response to my concern about Government amendment No. 23.

Peter Atkinson: I should like in particular to address amendment No. 6, which relates to the setting up of strategic health authorities. I echo what my hon. Friend the Member for West Chelmsford (Mr. Burns) said about primary care trusts, as I believe that they have been established too quickly. We often attack the Government for dragging their feet and not producing the documents that we want. For example, in the north-east, we are waiting for a White Paper on regional government—indeed, we are waiting, waiting and waiting. However, in this case, the speed of the changes has been far too great.
	An interesting example is the speed with which local health authorities in the north-east had to operate in order to set up a strategic health authority and carry out the consultation that was involved. The Department of Health launched the initiative on 7 September and it had to be finished by 30 November. That was a very considerable job for four health authorities covering a population of almost 2 million. Indeed, it was an enormous job. The chief executives of the health authorities that cover Northumberland, Newcastle and north Tyneside, Gateshead and south Tyneside and Sunderland joined together and set up a small project team in order to carry out the consultation, and it is worth considering what they achieved in that period. They held 38 meetings with the public, and dished out 6,000 copies of the consultation document and 33,000 copies of the summary leaflet. That was all done within the very tight space of time that I have mentioned. Moreover, 12 public meetings were held—one in each authority area. A proper presentation was given at each meeting, but sadly they were not well attended, as so often happens, especially when so little warning is given.
	One of the results of such a rushed operation was that members of the general public did not have an opportunity to register what was going on and attend the meetings. We cannot blame the project board for trying, but given the Government's rushed timetable, it was impossible to interest very many local people. The board helpfully published a summary of the consultation process. As well as mailing all the usual suspects, including local authorities, parish councils and so on, it tried to seek publicity in the media and picked 4,000 people at random from electoral registers in order to write to them. The net result, however, was that the biggest attendance at any of the public meetings was in Gateshead, where 20 people attended. The worst attendance was in Ashington, where only one member of the public turned up.
	I regret to say that in my constituency, where many people are extremely interested in what goes on, only six people turned up. I know my constituency well, so I am aware that there is very strong community spirit in Hexham. It seems inconceivable that only six people in Hexham were interested in attending a public meeting relating to a matter as important as the establishment of a new strategic health authority and all the primary care trusts that flow from it. Responsibility for what happened can be laid directly at the door of the rushed consultation process. 5.30 pm
	It is worth dwelling on the results of the meetings, which comprised professionals as well as members of the public. The summary states:
	"At most meetings comments were made about the pace of change and the enormity of the proposed changes. This was particularly in terms of the responsibilities for primary care trusts as new or developing organisations."
	That was much on people's minds. The major anxiety of those involved in providing health care in the north-east was that great change was being made extremely quickly. My hon. Friends have identified that, and I do not understand why Ministers have to rush all the changes.
	The summary also concluded:
	"At most of the meetings there were comments about the potential for public confusion with so many organisational changes taking place within the NHS."
	Again, members of the public, those involved in local authorities, health professionals and members of community health councils were worried that the process was being rushed and that more time was needed.
	Another lesson is that most people wanted information about the operation of the new systems. They wanted reassurance that the process of change would not create instability in the health service and the health economy. Our amendments are important because it is not necessary to rush matters. I do not understand why the Government should launch a consultation process to set up a strategic health authority that will serve nearly 2 million people on 7 September and expect it to be in place by April 2002, when we are still discussing the measure that relates to it in January.

Mark Francois: I want to deal with two specific matters: primary care trusts and strategic health authorities. In an earlier intervention, I gave the example of the Rochford primary care trust, which covers part of my constituency and several GP practices in Castle Point. I said that when it was a primary health group, it hesitated before applying for trust status, partly because some GPs were anxious about the pace at which the Government were attempting to push the process forward. I understand that the PCG has now applied for trust status, and that it has recently received formal approval from the Department of Health, or is close to doing so.
	In the past few years, GPs have had to cope with a tremendous amount of organisational change, such as the abolition of GP fundholding and its replacement by PCGs. Just as GPs were adjusting to the changes, the Government decided that they wanted them to be organised in PCTs rather than PCGs. More responsibility is associated with the former. Today, the Secretary of State made a speech which, it is worth reiterating, was not delivered in the House. He said that there may be further changes to the organisation and responsibilities of PCTs. I cannot pursue that further now if I am to remain in order. However, it is fair to point out that there will have been three, potentially four, major changes in almost as many years to the organisation by means of which GPs deliver primary care to the public.
	As we all know, GPs are busy. They can be expected to accommodate only so much change without its adversely affecting their ability to provide an adequate service to the patients whom they serve.
	I shall give a practical example from my constituency. In the town of South Woodham Ferrers, a number of GPs have lists in excess of 2,000 patients long; one has a list in excess of 3,000. It defeats me how people who have to cope with that many patients can also realistically be expected to find the time to cope with yet more organisational change of the type alluded to earlier today.
	All the strategic health authorities were originally meant to be going live by 1 April this year. The Government have said repeatedly that they intend to adhere to that deadline, despite being told by many people who work in these areas that it would be practically impossible to do so. We are now some two and a half months away from that deadline, yet the senior appointments have not yet been confirmed in many strategic health authorities. Even in those SHAs whose chairmen and chief executives have been confirmed, the principal directors who will report to them have, in most cases, not been. The senior management teams in a large number of the SHAs are not yet in place, even though they are supposed to go live some two and a half months from today.
	There are other major issues to consider as well as the management of the SHAs. The place in which a number of them will be located has not yet been determined. Furthermore, the information technology systems that the SHAs will use has in many cases not been determined, particularly in cases in which perhaps two or three health authorities are being merged into one SHA. Funnily enough, in a number of cases, we find that they are all using slightly different IT systems, which will now require a great deal of work to make them all talk to one another. Alternatively, some of the SHAs might have to go back to square one, abandon the legacy systems that have been inherited and come up with an entirely new IT system.
	These are all significant issues that will require a great deal of time and careful thinking. Yet, in theory, all these problems up and down the country will be solved in a matter of a few months. The people working in these areas are putting in tremendous hours to try to make all this happen in the allocated time, but realistically it is not enough. There is only so much that human effort can achieve.
	It is worth stressing these points for one fundamental reason. Even leaving aside what has been said this morning and this afternoon, the creation of primary care trusts—and the movement of responsibility and, particularly, funding to those trusts—is a fundamental part of the Government's 10-year plan for the national health service. The creation of strategic health authorities is also an important part of that plan. If these elements are so important to the Government's overall conception, it seems ridiculous to rush them through in such an ill thought out way. If these key building blocks for the scheme are not launched successfully, the whole plan will be in danger of unravelling.
	It is not unreasonable to point that out to Ministers, or to ask them, at the eleventh hour, to pause and allocate more time, to give these already overworked people a fighting chance of trying to bring this off.

Andrew Murrison: I am happy to say—and the Minister will be pleased to hear—that in Wiltshire, we are well ahead of the power curve in relation to turning PCGs into PCTs. I am conscious, however, of areas of the country in which that is simply not the case. I support PCTs; the Government have built a cogent way ahead for primary care and I welcome that. My concern is that this fundamentally good plan is, as my hon. Friend the Member for Rayleigh (Mr. Francois) said, destined to fail in many areas of the country if it is not given sufficient time.
	This week, the Health Service Journal has told us that delays in publishing guidance on the roles and responsibilities of management boards running strategic health authorities are causing grief for 27 chief executives appointed so far. We naturally assume that those people would feel buoyed up by their appointment to new roles, or indeed relieved to have jobs at all at a time of uncertainty in the health service, yet they appear to be fairly critical and worried about the fact that there are aspects of the job about which they are not certain.
	That suggests to me that Ministers have handed down an unrealistic timetable for implementing the changes. Indeed, the second national tracker survey of 71 primary care trusts and primary care groups, which was supported by the Government, says:
	"Progress in commissioning, health improvement and partnership working is slower. Lack of reliability and timely information and insufficient managerial capacity remain".
	In other words, the system is creaking under the pressure of changes in the NHS, which is not in a state to accommodate these changes in this time scale.
	May I deal with strategic health authorities, because they have caused considerable grief across the country? A principal reason for that is that they have been insufficiently explained to people. Although it is not for me to be an apologist for the Government, I have spent considerable time reassuring those who have written to me that the SHAs and the boundaries that they impose should not impact on clinical networks and people getting health care as they do at the moment. The fact that they are worried and have had to contact me suggests that the changes are being pursued in such a way and according to such a brief time scale that the message is simply not getting across.
	We have heard from the British Medical Association how many loose ends remain, particularly in relation to SHAs. It is concerned about academic medicine, which is in a parlous state. We have yet to hear how SHAs will further the agenda for it. Insufficient thought has been given to that, which shows that insufficient time was available for Richmond house to get its head round the complexity of the NHS and how the proposals will melt into it and improve the situation.
	We have yet to hear whether tertiary health services will be the responsibility of SHAs, how PCTs will fit in or whether the regions will have a part to play. In other words, there is confusion—we have not been told. Again, that is not so much the fault of Richmond house or of Ministers; it is just that these things take time to work through, but the time scale is far too tight for that. I fully support the creation of PCTs, which is a positive move for primary care that is to be warmly welcomed, but I share the concerns of my hon. Friends that, in their haste, the Government risk the whole thing tumbling down like a pack of cards.
	It is ironic that we are discussing the pace of change and, indeed, change of this nature as a Gallup poll published today shows that 40 per cent. of people think that the NHS is getting worse. Admittedly, a cheery and fairly optimistic minority of 13 per cent. reckon that it is getting better, but the balance think that it has remained static. It is difficult to see how the Bill will improve health outcomes—health care to patients—and I have yet to work out how that will happen.
	The Government are intent on driving the Bill through, but I urge them to revisit the timetable to which they have committed themselves. In that helpful spirit, I draw their attention to the new clause.

John Baron: As the Minister is well aware from our deliberations in Committee, I, too, have reservations about the speed at which the reforms are being introduced. I am especially concerned because—if we are to believe the figures—by September 2004 75 per cent. of all spending will be dictated to a large extent by the PCTs. I am also in favour of the concept of localising health care as much as possible to ensure that patient care is given appropriate attention and meets required standards. My concern is that the speed of the reforms will put in jeopardy the foundation stones of the Bill, which in essence I support.
	The National Primary Care Research and Development Centre, in collaboration with the King's Fund, has carried out a second national tracker survey of 71 primary care groups and trusts. Professor David Wilkin, the project director of the survey, has commented that
	"there is a real danger the management of the organisational changes is going to divert attention from the core functions of improving care."
	He said that the pace of change was being dictated by Government timetables rather than a
	"process of learning and building on experience."
	He believes that improvements can be made but that
	"it's important to make sure we are not trying to do everything at once."
	The PCTs, where they exist, are relatively new organisations and the demands outlined may be beyond their existing capabilities. The PCTs need time to bed in and to get used to the important roles that they will perform in the new structure of the NHS. PCTs are already experiencing difficulties in recruiting clinical staff and those staff able, willing and competent to participate in the new functions. I have visited PCTs—as, I am sure, have other hon. Members—while they are taking on those new responsibilities, and have heard their concern that they cannot find the required calibre of management to fulfil the functions envisaged in the Bill in such a short time. Whether the deadline is spring 2003 or October 2003—as mentioned in Committee—it is an ambitious timetable given the tasks involved. There are some 120 PCGs, many of which are in the early stages of converting to PCT status.
	I have two specific concerns about funding, and I would appreciate it if the Minister would address them. First, will PCTs be saddled with the outstanding deficits of health authorities as part of the devolution process? That would leave the PCTs without the resources to implement their devolved responsibilities, let alone achieve the Government's targets. Arguably, with ever increasing central directives and no additional resources, there will be little opportunity to improve the provision of health care over and above that achieved by the authorities the PCTs are to supplant.
	My second concern is that it is unclear whether PCT funds will be protected from the revenue consequences of any major building projects. If PCTs are not protected from those consequences, concerns will arise in areas where boundary changes following the establishment of strategic health authorities mean that PCTs may retrospectively become liable for the revenue consequences of a major building project.
	I am sure that the House would appreciate clarification from the Minister on those two issues. We all know that the devil is in the detail with a Bill of this sort, but those two examples give rise to the legitimate concern that the reforms—especially the establishment of PCTs—are being rushed through without due consideration for the consequences. I for one would much appreciate the Minister's clarification on those issues.

John Hutton: I start by referring to Government amendment No. 23 and the Opposition amendments that relate to it. As hon. Members who were members of the Standing Committee will be aware, I agreed in Committee to reflect further on the need for an amendment to provide statutory provisions concerning consultation in respect of the names, boundaries and mergers of strategic health authorities. It is clear that the Bill should now make statutory provision for such consultation and Government amendment No. 23 has been tabled to give effect to that.
	I would like to place on record my gratitude to the hon. Member for West Chelmsford (Mr. Burns) and to my hon. Friend the Member for Leigh (Andy Burnham) for drawing my attention to the issue in Committee. It will come as no surprise to the hon. Member for West Chelmsford that I do not think that amendment. No. 6 is necessary. It would restrict the requirement for consultation to health professionals, local authorities and the public.
	Amendment No. 23 allows for much wider consultation than the hon. Gentleman is proposing. I have concluded that, given the level of detail required, it would be best to deal with this issue by means of regulations rather than in the Bill. This is in line with, for example, the provisions for consultation on NHS trusts set out in the National Health Service and Community Care Act 1990—legislation introduced by the previous Conservative Government.
	In part, that addresses some of the arguments that I wanted to deploy against amendment (a), tabled by the hon. Member for Oxford, West and Abingdon (Dr. Harris), which would put a duty on the Secretary of State to make regulations. We have also already carried out extensive consultation in relation to the first wave of SHAs—the hon. Member for Hexham (Mr. Atkinson) and others have referred to that—and we do not want to have to re-run that process. That would not be in anyone's best interests.
	The vast majority of other regulation-making powers in primary legislation—concerning consultation on, for example, health authority structures and boundaries—do not put a duty on the Secretary of State. We have followed the standard pattern in drafting our amendment, which I hope is acceptable to the House.
	The hon. Member for Oxford, West and Abingdon was in some confusion about the Government's intentions. I want to make it clear to him that the Secretary of State will make the regulations about consultation for SHAs. There would be precious little point in tabling the amendment if he were not of a mind to do that.
	I also want to make it clear that we certainly do not place a lower importance on consultation in the new NHS. It is very important that we involve and carry with us the public, who will be affected by the direction of reform that is being implemented through the NHS. They have a democratic legitimacy and an entitlement to make their voices and views heard at all levels when change is being proposed to health organisations and structures and to local health services.
	Rather than preview some of the arguments that the Under-Secretary of State for Health, my hon. Friend the Member for Salford (Ms Blears), will go through later, I shall say that it is clear that the reforms that we are asking the House to support today will strengthen and not weaken the role of public participation and involvement in the NHS.

Evan Harris: As the Minister has been so clear, it is likely that I will suggest that this matter is not pursued in the House of Lords if the norm in these circumstances is that there should not be a duty to make regulations, but that the Secretary of State "may" do so. Will he reflect, however, on whether the Government—rather than he himself—are very good at consulting? We have heard announcements today about the structure and functioning of NHS trusts, on which there has been very little consultation.

John Hutton: There is an established and democratic procedure for how these things are done. It would be an unusual constitutional innovation for Opposition Members—I know that it is not being proposed today—to impose a statutory duty on a Secretary of State to consult before he was minded to announce any change of policy or to look at a way in which reform might be taken forward. There is a reasonable case for saying that when substantial reform is proposed to the NHS, there should be consultation. That has always been the spirit and practice of the Government; it is one that we intend to take forward. It cannot be argued—in terms of either the Bill or the amendment—that the Government in any way diminish the role of the public, or the voice of the public being heard effectively in the affairs of the NHS; far from it.
	Amendment No. 7 would impose a duty to consult before a health authority was established in Wales. However, it is clear that health authorities in Wales will only continue to exist until they are abolished on 31 March 2003. The policy intention in Wales is to create local health boards, as covered in clause 6. The only practical effect of the amendments would be to fetter the devolved powers that the House has already granted to Wales under the Government of Wales Act 1998. While there is no requirement to consult on the establishment of a health authority, the Welsh Assembly has conducted a full and open consultation in relation to the establishment of local health boards in Wales.
	The remainder of this group of amendments deal with technical issues to do with the boundaries of primary care trusts. Following the consultation on the new SHA boundaries, it has become clear that a small number of PCTs—perhaps two or three—will cross the new SHA boundaries. Current legislation does not explicitly state that PCTs which cross health authority boundaries must not be established, but there is an underlying assumption in the way in which the Bill has been drafted that all PCTs will, in fact, fall within one health authority. It remains our intention that, in the vast majority of cases, PCTs should not cross the boundaries of SHAs.
	There is an argument to be made about the value of consultation and the importance of listening to local voices about where boundaries should be drawn across the NHS. For local flexibility to be maintained, and so that clinical networks—rightly referred to by the hon. Member for Westbury (Dr. Murrison) as important—should not be disrupted, it is important that, in those exceptional cases, it should be possible for PCTs to straddle SHA boundaries, if those boundaries have strong local support and make obvious sense.
	The Government amendments make provision for allowing PCTs which straddle SHA boundaries to be established—putting that issue beyond doubt—and provide for each SHA to receive the PCT's annual financial, patients forum and other reports. In essence, this group of amendments will serve to preserve maximum flexibility around PCT boundaries; that supports the principles of local decision making, which is fully consistent with shifting power and responsibility to the front-line. There are a number of points in primary legislation that need to be amended to allow for this, and that is why this group of amendments is relatively large.
	Amendment No. 25 makes a number of amendments to schedule 5A of the National Health Service Act 1977: to allow any SHA in whose area the PCT is established to meet preparatory costs; to allow any SHA to make available premises and other facilities during the preparatory period; and to provide for the PCT's annual financial and other reports to be sent to all SHAs in whose area the PCT is established.
	Amendment No. 26 provides for any SHA in whose area the PCT is established to give directions to that PCT. Amendments Nos. 35 and 36 make provision for the reports of patients forums to go to all SHAs in whose area the PCT is established. Amendments Nos. 24, 27, 28, 54, 55 and 61 make minor, consequential and technical amendments that are necessary to give full effect to the policy intentions.
	The bulk of our time this evening has been spent on new clause 1. I understand fully the concerns expressed by Opposition Members about the pace of change and the way in which the reforms are being handled. However, as was the case when the previous Administration attempted organisational reform of the NHS, there will always be those who say that that should not be done. There will be those who say that it is being done too quickly; some will say that it is the wrong reform.
	We have heard all those arguments this afternoon. Of course, when deciding the pace at which change should be made, the Government have to weigh the upheaval and disruption that a change of this scale and magnitude will inevitably cause against the benefits that we envisage that it will bring.
	The Government have to find the balance between those two competing arguments, and we cannot pretend that they can be spirited away somehow. We therefore must be clear that the reforms, whose potential benefits for the NHS were questioned to some extent by the hon. Member for Westbury, will bring about substantial improvements in the performance, management and delivery of health care services. We are clear about that, and I hope that Labour Members in general are too.
	As my right hon. Friend the Secretary of State made clear today, the NHS is a large organisation. It has more than 1.2 million employees and treats more than 20 million patients a year. It operates in all our constituencies, at a number of different levels of intensity. It is inconceivable in this modern age that the sort of care that we want to be available could be delivered by the structures that presently exist, given the pressures on services, the introduction of new technologies and the speed at which things change in the delivery of medical services.
	Therefore, the change has to happen. It is necessary, although of course it will be difficult for some. That is always the nature of any substantial and radical reforms. These are radical reforms, but our judgment is that they will benefit patients, and therefore all our constituents.
	I was interested to hear Opposition Members say that they supported the reforms in general terms, but that their primary concern was about the speed at which the reforms were being introduced. As I said, I fully understand those concerns, but I think that the Government have got the balance and the judgment right.
	I am sure that the hon. Member for West Chelmsford moved new clause 1 with the best of intentions, but I do not believe that he has thought through the new clause's implications. First, it would create a new and I believe rather inappropriate role for the health service commissioner, which would add considerably to his already substantial work load. It would also be beyond the role envisaged for him under the Health Service Commissioners Act 1993.
	Also, new clause 1 could disrupt the provision of health care services, as it would create a vacuum while PCTs were being investigated, especially in relation to their new responsibilities for family health services. That point was made by my hon. Friend the Member for a Birmingham constituency that I cannot call to mind just now—

Evan Harris: Selly Oak.

John Hutton: I was referring, of course, to my hon. Friend the Member for Birmingham, Selly Oak (Lynne Jones). It is a very fine part of Birmingham, and I have visited it.
	It is not clear from the new clause who would be responsible for commissioning and delivering health care services. Moreover, it assumes that all the functions being allocated to PCTs will be new to them. That thread of misconception underlay most of the arguments presented by Opposition Members, as many of the functions to be directly conferred on PCTs are being exercised by them already, on behalf of their health authorities.
	The main difference is that the Bill will mean that PCTs will assume responsibility for all family health services. I accept that that is a substantial change, but many of the arguments about the readiness of PCTs to discharge their new responsibilities overlook the fact that many have already been established successfully, and have been delivering their wider commissioning responsibilities for some time.
	In Standing Committee, I made it clear that we anticipated that all primary care groups will have gained PCT status before October 2002. In fact, 86 new PCTs have been approved by Ministers for April 2002, and 58 further applications are still with Ministers for approval. I expect that the vast majority of those will be approved in the very near future. Therefore, given that 164 PCTs are already in operation, it is clear that the majority of the country will be covered by April 2002.
	In Committee, I referred to 11 primary care groups that were still consulting on the proposals. Of those, 10 have now applied for PCT status. Their submissions are with Ministers and have been included in the figure of 58 applications that I mentioned earlier. The remaining PCG intends to apply for PCT status, and that application will be considered as soon as possible.
	Therefore, to suggest that PCTs lack the capacity to deliver their new responsibilities simply ignores the truth of the matter. Better support is already being given to practices and clinicians, and services are better integrated and more effective. There is better access, and decision making is carried out closer to patients and local communities.
	In the debate, an extensive reliance was placed on the tracker survey commissioned out by the national primary care research and development centre at Manchester—another excellent academic centre—in collaboration with the King's Fund. As Opposition Members rightly noted, the survey covered 72 of the 481 primary care groups established in 1999. The survey covered a three-month period between October and December 2000.
	I do not dispute the accuracy of the data at the time, but it is historic information. The Opposition rested their entire case for new clause 1 on the results of a tracker survey, and I think that that was a total mistake. Given the information available, and the concerns that have been raised about the performance of PCGs and PCTs, the hon. Member for West Chelmsford would have had a reasonable argument if the Department of Health had done nothing. However, no mention was made of the effort that has been put in since the tracker survey was published to provide better and more effective support to PCGs and PCTs, as they take on their new responsibilities.
	Those efforts continue to be made. The new leadership centre proposed in the NHS plan will play an important role. In addition, Barbara Hakin, an outstanding PCT chief executive from Bradford, is leading the management development programme for new PCT senior managers. Her excellent services are beginning to make a significant and positive contribution.
	Some people will always say that a reform of this magnitude is wrong, or a source of concern. I do not doubt for a second the legitimacy of such arguments, or the right of people to express them. Of course people who are worried about reform should express their unease, but the view should not be formed that other people—equally eminent and respectable—have not expressed positive and supportive views about the pace and direction of change.
	The argument this afternoon has been very one sided, as it was in Standing Committee. It is fine for Opposition Members to express their concern, but they should also acknowledge the positive developments that have taken place and the progress that has been made. If the Conservative party wants to be an effective Opposition who scrutinise legislation properly, Conservative Members must be able to make both sides of the argument, as that would certainly improve the quality of legislative scrutiny.
	It would also be wrong to assume that PCTs are not getting the support that they need, as I have tried to make clear. Therefore, I believe that new clause 1 is mistaken, and I am not entirely sure of the motivation that lies behind it. It was designed as an amendment that would help the Government's reform programme, but we must beware of Greeks in that situation.
	With respect to the hon. Member for West Chelmsford and to other hon. Members, the arguments in favour of new clause 1 are not persuasive, and I cannot ask Labour Members to support it.

Mark Francois: Either by accident or design, the Minister has said very little about strategic health authorities. Does he accept that it is integral to the Government plan that the SHAs must succeed? Is not it also a part of the plan that merging other health authorities into SHAs is a deliberate attempt to reduce head counts and thus to free up more money for patient care? Everyone realises that there will be job losses as a result of the mergers. Is not the Minister asking people to work flat out, on an incredibly tight timetable, to get the SHAs up and running, even though those same people have no idea whether they will have a job in the surviving organisation in a few months time? Is not—

Mr. Deputy Speaker: Order. The hon. Gentleman has made his point.

John Hutton: The hon. Gentleman has certainly done that, but I was not referring in detail to SHAs, as the amendments are about PCTs. I was trying to explain the Government's thinking about the establishment of PCTs, and about whether that should be delayed. I have mentioned the duty of consultation on SHAs—

Mark Francois: On a point of order, Mr. Deputy Speaker. This group of amendments comes under the heading "Establishment of Strategic Health Authorities and Primary Care Trusts".

Mr. Deputy Speaker: That is not a point of order for the Chair.

John Hutton: I do not want to delay our proceedings. We are talking about new clause 1; the hon. Gentleman interrupted me when I was talking about new clause 1, which is about primary care trusts and not strategic health authorities. I dealt with the arguments on strategic health authorities when I referred to Government amendment No. 23 and the amendment that has been proposed to it. I am not short-changing the House, nor am I ignoring the arguments that the hon. Gentleman has been trying to deploy.
	The hon. Gentleman is right that organisational changes may mean that people lose their jobs as a result. The NHS has a responsibility; we will discharge it to make sure that we act fairly in relation to the employees at all times during the process of change. There are exciting new opportunities presented by the reforms for which we seek the House's support, particularly in relation to the new roles and responsibilities of primary care trusts. The hon. Gentleman, who takes a close interest in these matters, will know that many currently working in health authorities are looking towards employment in the new primary care trusts and will find employment in that area.
	The hon. Gentleman's wider point about what should motivate the Government as they consider these reforms is fair. What motivates us is a simple desire to improve the quality of the national health service. We will do that, in this instance, by making the NHS more streamlined, less bureaucratic, more focused on patient care and making sure in the process that we get better value for the record investment in the national health service. That is an entirely appropriate responsibility for the Government and Ministers to discharge, so I shall certainly not apologise to the hon. Gentleman or to anyone else for those considerations.
	Amendments Nos. 8 and 9 deal with funding arrangements under the new system. Amendment No. 8 would require the Secretary of State to take into account the assets and liabilities contained in the balance sheet when determining allocations to primary care trusts. This area is inevitably technical and complex, but I will try, as far as possible, to keep the issues simple, not only so that the House can understand them but so that I can.
	Usually only those assets and liabilities associated with the functions assumed by the PCTs will transfer to them. The process is that PCTs agree with the relevant health authorities and, where appropriate, NHS trusts the balances that will transfer. These amounts will normally be straightforward and attributable to specific PCTs. However, there may be cases in which that is not appropriate or practicable. That might include any small outstanding health authority running cost charges which cross boundaries—utilities bills, for example—or there may be circumstances in which an under or over- performance on service agreements, such as maternity services, might have arisen. In these circumstances, other equitable methods will be used, such as a simple apportionment.
	Turning to the financial consequences of transferring a liability to a PCT, as we would expect in any public or private sector body, there will always be amounts due in income and amounts due to be paid at the year end. In the case of health authorities, most of those sums will be moneys owed to and from other NHS bodies. PCTs will inherit these balances from health authorities. I think that that is fair and reasonable. The overall resources available to PCTs for spending on health care in-year, however, will be unaffected by these inherited balances.
	Cash will, of course, be required by the PCT physically to discharge the liability at some point in the future. However, that is largely a question of timing and can be taken into account if necessary when agreeing the cash financing of the PCT. As a strict consequence, the amendment is unnecessary.
	The practical effect of amendment No. 9 would be to require the Secretary of State to take into account the health needs of a primary care trust's population when he makes an allocation. We all accept that different parts of the country and different localities have different health care requirements and needs. I agree with the hon. Member for Oxford, West and Abingdon on that. It is partly a reflection of deprivation but may also be a result of geography. The national resource allocation formula that we use to determine fair shares for health authorities and primary care trusts recognises this. It is already used to establish fair share targets for primary care trusts, and while allocations are still made to health authorities, they are required to pass resources on to primary care trusts in accordance with national guidance.
	We have asked the Advisory Committee on Resource Allocation to review the operation of the formula at primary care trust level. When in future we allocate resources direct to primary care trusts, we will have a national formula that takes into account the health needs of a primary care trust's population. We will have a pace of change policy to bring primary care trusts towards their targets, or fair shares, determined by the formula.
	Allocations to local authorities—probably the most obvious and direct comparison that we could make in this context—are determined on comparable formulae, which also need to take into account many different issues. As with those for health authorities and PCTs, and in order to preserve maximum flexibility in a rapidly changing area, the formulae used by the Department for Transport, Local Government and the Regions are not set out in primary legislation. Neither is the formula for allocations to NHS organisations. It has never been the policy of successive Governments to specify part or all of the detail of the formula or the issues that should be taken into account in determining allocations to NHS organisations, whether PCTs, trusts or health authorities. There are powerful and convincing arguments for not doing that.
	To some extent, amendments Nos. 8 and 9 are contradictory. Amendment No. 9 wants health care needs to be the basis upon which allocations should be determined to NHS trusts and PCTs, but amendment No. 8 wants the Secretary of State to take into account the financial liabilities of those organisations as well. I do not want to make a meal of this, but the hon. Member for West Chelmsford is to some extent pointing in two different directions on this. Is it a question of need or of a range of financial circumstances? He cannot have it both ways.
	One could play devil's advocate and raise the question of surpluses. If one is to take account of liabilities under the hon. Gentleman's formula, why should the Secretary of State not take surpluses into account as well? I think it best to make sure that the allocation formula to trusts is based on health care needs. Meeting the health care needs of local people should be the exclusive determinant. That is precisely how we are addressing those issues.
	There is an argument, which the hon. Gentleman raised, about whether his health authority or trust is fairly funded compared with a range of others. Most Labour Members would find it difficult to see the fairness of the comparison between West Chelmsford and Sedgefield and other parts of the country that he was trying to identify. It is on the basis of equity and fairness that the NHS should be funded according to the health care needs of local people. So I cannot accept amendments Nos. 8 and 9.
	We have had a fairly full debate about these issues. We have gone over territory which is very familiar to those of us who served on the Standing Committee that considered the Bill. Conservative Members have raised a perfectly reasonable set of concerns, but my response to them, and to new clause 1 in particular, is that they have not acknowledged the progress that has been made since the second tracker survey was published. They have not weighed up, as we are required to do, the balance between the necessary changes, the organisational upheaval that they would impose on the service and the benefits to patients and the wider national health service. It is a complicated balancing equation, but our responsibility in government is to act first and foremost in the interests of patients. That is precisely what we are doing and why I do not want the House to accept the new clause.

Andrew Murrison: I am concerned about the Minister's dismissal of the second tracker survey, which is only months old. The work may have been carried out in the latter part of 2000 but it was published some time after that. If the right hon. Gentleman is so dismissive about the survey such a short time after its publication, why did he support it in the first place?

John Hutton: I am not dismissive of the tracker survey. We think that it is a very important piece of work. It has helped us to respond to the concerns and criticisms made at the time. That is why we have put into place a substantial programme of primary care trust development work right across the NHS. I am not dismissing the contribution that the tracker survey has made. I am simply disputing the use that Conservative Members are making of it for the purposes of this argument. That is a very different issue.
	In relation to these provisions, as to others, the House has an important decision to make tonight. These reforms are important and I accept that they are radical. However, they are motivated by a clear, simple and transparent principle—to make sure that as much responsibility, power and authority in the national health service is devolved as close to the front line as possible. That will allow the innovation, enterprise and experience of NHS managers to be used to the fullest possible benefit of staff, patients and the public as a whole. That is why the Bill should be supported by the House and the new clause, which has been considered carefully, should be rejected.

Simon Burns: I listened to the Minister with great care. As a humble Opposition Member, I should like to say how grateful I am that a crumb has fallen from the Government's table and that the Minister has seen the strength of the argument put by my hon. Friends and me in Committee, and that he has in effect accepted amendment No. 6—albeit by substituting it with Government amendment No. 23. I am delighted that he has seen common sense and accepted the wisdom of what we and—to be fair—the hon. Member for Oxford, West and Abingdon (Dr. Harris) were trying to do and has drafted an amendment of his own. We have to be grateful for small mercies and this is one of those occasions, so I thank the Minister for that.
	The Minister said that amendment No. 8 was horribly technical and that he did not want to go into the minutiae of its detail in case he confused my hon. Friends and me and, indeed, himself. Unusually I shall take the Minister at his word; I shall not press either amendment No. 6 or amendment No. 8 to a vote. I, too, am not qualified to argue on the minutiae of the amendment. Having listened to the Minister, I shall also not press amendments No. 9 and No. 7.
	I listened carefully to the Minister's remarks on new clause 1. Although the drafting of the provision might have been flawed and it might indeed have been improved, I am disappointed that the Minister is not minded to accept it. The new clause was a genuine attempt to try to help the Government, as I said earlier. If the House is to change a crucial system that relates to two pillars of the NHS—its funding and its seamless provision of care—one obviously wants to ensure that the service works smoothly during the changeover from one system to another.
	From the evidence that my hon. Friends and I have provided, both in Committee and during today's debate, we believe that there could be problems. As many of us pointed out during the debates on the Bill, we are not alone in expressing such concerns: health professionals and respected professional bodies such as the BMA have all expressed concern. However, I accept that the Government have the whip hand.
	We have made a genuine attempt to try to help them, but they feel that our help is unnecessary and that things will be all right on the night. The jury is out on that. As a responsible Member of the House I hope that I am wrong. No one wants the system to be fraught with problems and mistakes. No one wants a hiccup in the provision of health care for our constituents, so I hope that I am wrong.
	I do not know whether I am wrong; equally, I am not convinced that the Government know that they are right—we shall see. I reiterate that I hope that we are wrong. I hope that the system is seamless and that our constituents do not experience disruption or problems. We have tried our best.
	As the Government are not prepared to take the lifeline of help that we are responsibly offering them, I beg to ask leave to withdraw the motion.
	Motion and clause, by leave, withdrawn.

New Clause 2
	 — 
	Community Health Councils: scheme for reform

'.—(1) The Secretary of State shall lay before Parliament within 12 months of the date of coming into force of this section regulations setting out a scheme for the reform of the Community Health Councils in England.
	(2) The scheme set out by the Secretary of State in regulations under subsection (1) above shall extend to all parts of the health service (including the provision of Part II services under the 1977 Act).
	(3) The Secretary of State may make regulations providing for access by members of a Community Health Council to premises from which services under Part II of the 1977 Act are provided.
	(4) The scheme set out by the Secretary of State in regulations under subsection (1) shall provide for the proper representation of the population in the area served by a Community Health Council on that council.
	(5) Regulations under subsection (1) may not be made unless a draft of the statutory instrument containing the regulations has been laid before, and approved by a resolution of, each House of Parliament.'.—[Mr. Burns.]
	Brought up, and read the First time.

Simon Burns: I beg to move, That the clause be read a Second time.

Mr. Deputy Speaker: With this it will be convenient to discuss the following: new clause 5—Establishment of Patients' Councils—
	'(1) The Secretary of State shall, subject to subsection (2) below, establish a body to be known as a Patients' Council ("Councils") in England in each area for which an overview and scrutiny committee has been established under section 7 of the Health and Social Care Act 2001 (c.15); each council shall be appointed from among members of relevant Primary Care Trust Patients' Forums and NHS Trust Patients' Forums operating in that area and representatives from relevant community interest groups.
	(2) Where it appears to the Secretary of State that there is a need to establish a Council for an area other than that represented by a local authority with overview and scrutiny functions, he shall, after local consultation, establish a Council for such other area as appears to him will meet the needs of the local community.
	(3) The functions of a Council are to represent the interests in the health service of the public in its district and in particular to—
	(a) facilitate the co-ordination of the activities of member Patients' Forums including by the provision of staff and services to Patients' Forums,
	(b) provide or make arrangements for the provision of services under section 19A of the NHS Act 1977 (independent advocacy services) at the direction of the Commission for Patient and Public Involvement in Health,
	(c) represent to persons and bodies which exercise functions in its area (including in particular the overview and scrutiny committees and the joint overview and scrutiny committees mentioned in sections 7, 8 and 10 of the Health and Social Care Act 2001) the views of members of the public in its area about matters affecting their health,
	(d) advise the bodies mentioned in subsection (4) on involvement of the public in its area in consultations or processes leading (or potentially leading) to decisions by those bodies or the formulation of policies by them, which would or might affect (whether directly or not) the health of those members of the public, monitor the effectiveness of this involvement and co-operate with the Commission for Patient and Public Involvement in Health in carrying out this function.
	(4) The bodies referred to in subsection (3)(d) are—
	(a) health service bodies,
	(b) other public bodies, and
	(c) others providing services to the public or a section of the public.
	(5) The Secretary of State shall, following consultation with the Association of Community Health Councils for England and Wales, Community Health Councils, patients' and carers' organisations and the wider community, by regulation make provision in relation to Councils as to—
	(a) the Patients' Forums and other community interest groups from which members of the Council are to be appointed,
	(b) any qualification or disqualification from membership,
	(c) terms of appointment,
	(d) the proceedings of a Council,
	(e) the discharge of any functions of a Council by a committee of the Council or by a joint committee appointed with another Council,
	(f) the circumstances in which Councils will co-operate with each other in the exercise of their functions and exercise functions jointly with one or more other Councils,
	(g) funding of Councils and the provision of staff, premises and other facilities,
	(h) the preparation and publication by a Council of annual accounts,
	(i) the provision of information (including descriptions of information which are or are not to be provided) to a Council by an NHS Trust, a Primary Care Trust, a Strategic Health Authority, the Commission for Patient and Public Involvement in Health, the relevant local authorities or a person providing independent advocacy services (within the meaning given by section 19A of the NHS Act 1977),
	(j) the provision of information by a Council to another person,
	(k) the preparation and publication of reports by Councils,
	(l) the furnishing and publication by NHS trusts, Primary Care Trusts, Strategic Health Authorities and Overview and Scrutiny Committees of comments on reports or recommendations of Councils, and
	(m) the referral of matters of a prescribed description to any overview and scrutiny committee, the relevant Strategic Health Authority, the Commission for Patient and Public Involvement in Health or the Secretary of State.
	(6) The regulations shall include provision applying or corresponding to any provision of Part 5A of the Local Government Act 1970 (c.70) (access to meetings and documents).
	(7) In section 21(10) of the Local Government Act 2000 (membership of overview and scrutiny committees) after the words "who are not members of the authority" there shall be inserted ("and shall include a person appointed by the relevant Patients' Council").
	(8) In paragraph 1 of Schedule 1 to the Health Authorities Act 1995 as amended by this Act after "(c) a prescribed number of officers of the Health Authority" there shall be inserted—
	"(d) persons appointed by the relevant Patients' Councils.".'.
	New clause 7—Duty of Secretary of State and Strategic Health Authorities to consult—
	'In subsection 11(2) of the Health and Social Care Act 2001, paragraph (a) is omitted and the following is inserted—
	"(a) the Secretary of State,
	(aa) Strategic Health Authorities,".'.
	New clause 8—Functions of overview and scrutiny committees—
	'(1) In subsection 7(1) of the Health and Social Care Act 2001, after "recommendations" the words "and referrals to the Secretary of State" are inserted.
	(2) In subsection 7(3) of that Act, after paragraph (a) there is inserted—
	"(aa) as to matters relating to the health service in the authority's area which the committee may refer to the Secretary of State,".'.
	Amendment No. 1, in clause 15, page 20, line 2, leave out Clause 15.
	Government amendments Nos. 33, and amendment (a) thereto, and 34.
	Amendment No. 2, in clause 16, page 21, line 4, leave out Clause 16.
	Amendment No. 73, line 20, at end insert—
	'(but for the purposes of this section "promises" shall not include the private living quarters of any person)'.
	Amendment No. 3, in clause 17, page 21, line 31, leave out Clause 17.
	Government amendment No. 37.
	Amendment No. 4, in clause 18, page 22, line 13, leave out Clause 18.
	Amendment No. 70, in page 22, line 27, after "Forums", insert—
	'by the Commission for Patient and Public Involvement in Health'.
	Amendment No. 63, line 27, leave out "other facilities and staff" and insert "and other facilities".
	Government amendment No. 38.
	Amendment No. 64, line 37, after "by", insert "a Patients" Council,".
	Government amendment No. 39.
	Amendment No. 65, in page 23, line 1, after "by", insert "a Patients" Council,".
	Amendment No. 71, line 2, after "Authorities", insert—
	'and overview and scrutiny committees'.
	Amendment No. 72, line 3, after "of", insert ", or referrals from,".
	Amendment No. 66, line 20, after "Forum", insert ", a Patients" Council".
	Amendment No. 67, line 24, after "section 15" insert—
	'and a Patients' Council under section [Establishment of Patients' Councils]'.
	Amendment No. 68, in clause 19, page 23, line 43, after "Forums", insert "and Patients" Councils".
	Amendment No. 69, in page 24, leave out lines 5 to 10 and insert—
	'(g) coordinating and supporting the activities of Patients' Councils in respect of their activities provided for at subsection (3)(c) of section [Establishment of Patients' Councils],'.
	Amendment No. 5, in clause 20, page 25, line 23, leave out Clause 20.
	Amendment No. 11, in page 26, line 5, at end insert—
	'(7A) This section may not be brought into force until the Secretary of State has issued a certificate stating that in his opinion the bodies established under section 15 are fully functional and performing their duties effectively throughout England.'.

Simon Burns: Even at this late stage, new clause 2 will try to stop the Government making a pernicious and vindictive attempt to stifle any opposition to the abolition of community health councils. As most hon. Members in the Chamber will remember, there is a long history to this sad and sorry affair.
	When the Government introduced the Health and Social Care Bill during the last Parliament, they tried to remove CHCs. They were ruthless in their determination to brook no opposition in this place, to have their way and to ensure that the CHCs were removed by what is known in common parlance as a patsy—a lapdog of an apology for a forum for patients who had grievances against the local NHS in their area.
	Far too many people saw through that attempt to get rid of a "troublesome priest"—in the words of Henry II. The CHCs were a thorn in the side of the Government because they had the guts and the courage to represent the people they had been created to look after and to speak their mind about failure in the provision of health care locally or about injustice in the health service.
	The Opposition and—to their credit—several independently minded Labour Members fought the case vigorously, but the Government steamrollered the measure through the House before the general election. However, their attempt to abolish CHCs was thwarted by the common sense and experience of another place. The Government had to drop their disgraceful proposal so as to ensure that the remaining contents of the Health and Social Care Bill reached the statute book before Dissolution in May 2001.
	At the first opportunity in the new Parliament, the Government shamelessly brought back those proposals in this Bill, but for the life of me I cannot understand why. Community health councils were created as long ago as 1974. They represent and help members of the public within the orbit of the health service. They are independent bodies, which is crucial. They have teeth and power; for example, if a CHC does not agree with a health authority or a trust about a proposed hospital closure and formally objects, the proposal has to go to the Secretary of State for decision. They have built up tremendous expertise and experience in looking after patients, and the Under–Secretary will certainly be aware of that.
	I shall come to the Under-Secretary's role a little later, but she will be aware that I believe that CHCs have done more than enough to justify their retention. On average, they assist about 30,000 people a year. A recent poll conducted by Health Which? found that 84 per cent. of those who had contacted their CHCs found the advice given to them very or fairly useful, which suggests an extremely high satisfaction rate.
	Similarly, a recent report, "Hidden Volunteers", conducted by Community Service Volunteers, estimated that CHC members contributed through their dedicated work about £7.9 million worth of free labour to the NHS. No one in the Chamber would underestimate their work. They have been extremely brave. They have devoted a great deal of their time and effort to fulfilling their role, looking after those people whom it is their job to represent and help.
	What do the Government want to do? They want to abolish CHCs. I shall not be convinced by their reasons for wanting to abolish CHCs, whatever the Under- Secretary says, because there is only one reason: they do not like opposition. Those who oppose them and have the temerity to embarrass them, by highlighting failings in their policy or in its implementation, have to be silenced because they are out of kilter. That is an extraordinary reason to get rid of any organisation, and I shall be particularly interested to hear the Under-Secretary's response. I have heard her response once before in Committee, and I suspect that it will be along similar lines today.
	The Under-Secretary chaired Salford CHC from 1993 to 1997, so more than any hon. Member in the Chamber tonight she has a working experience and knowledge of how good CHCs are. I suspect that, between 1993 and 1997, she thought with justification—she chaired that CHC and she is an able individual—that Salford CHC was very good indeed at fulfilling its functions. I do not think for a minute that she wanted her CHC, or any other, to be abolished. As I am sure she would have said if the previous Government had proposed to abolish CHCs, they had an important, independent role to play, and they played it extremely well.
	Sadly, times have changed, and the Under-Secretary will stand at the Dispatch Box later tonight to seek to persuade her right hon. and hon. Friends to sign the CHCs' death note, which is a staggering turnabout in four to five years. I do not believe that the quality of the work done by CHCs has deteriorated in four or five years to such an extent that it warrants their abolition. If the Government feel that CHCs have a patchy record or that improvements need to be made in some of them, why do the Government simply not reform them and change the law to improve and strengthen them? Surely that is the right way forward.
	If satisfaction among CHCs' client group is high, if the perception is that they do a very good job in their local communities—the Under-Secretary was directly involved with them until relatively recently, and I assume that she thought that her CHC did a very good job, as I am sure it did—and if some of their functions could be performed even better, why not simply introduce legislation to strengthen and improve them?

Peter Atkinson: Would we not have a very much better idea of why the Government propose to abolish CHCs if we had got round to discussing clause 20 in Committee? It is worth reminding ourselves that it was not discussed because of the ludicrous system of timetabling and programming Bills. We are blind about the Government's real reasons for wanting to abolish CHCs.

Simon Burns: My hon. Friend is absolutely right to say that, because of the guillotine, the Committee had no opportunity to discuss what everyone considers the most important clause—clause 20. This, therefore, is the first time that we have been able properly to discuss the issue since Second Reading.
	We attempted to discuss CHCs during debates on an earlier clause, but we are never able to discuss any amendment that we might have wished to move in Committee because of the tightness of that guillotine. I am grateful to my hon. Friend for making that point, and I hope that the report of his intervention will be read with keen interest, especially in another place, when it has to deal with the Bill later this year.

Evan Harris: I have not followed the full detail of exactly which amendment the hon. Gentleman is talking about, but he will remember that, despite the guillotine, we had time to have a lengthy debate in Committee on whether CHCs could be reformed, not abolished, and that we voted on that amendment. We both agreed that we got little out of the Under-Secretary in terms of a considered response because she is passionate about her model, but most people prefer the model proposed in the new clause.

Simon Burns: The hon. Gentleman is absolutely right. The only disadvantage or sadness about the debates that we managed to have in Committee was that they were related to earlier clauses on the back of the Government's proposals; we were unable to have specific debates on clause 20, solely under which CHCs will be abolished. The debate that we had was better than nothing, but we would have welcomed proper and full debate at the time on the specific clause that deals with the abolition of the CHCs.
	The procedure that the Government have adopted to rid themselves of this network of councils throughout the country has been typified by a brazen lack of regard for the views of others. No doubt, those who support the Government on this issue will say that a consultation process took place. If they believe that, they will believe in a number of things that it is not wise to believe in.
	When the Government sent out their consultation document, the basic assumption in point 1.5, which deals with this issue, was that CHCs would be abolished. The document did not ask whether they should be abolished, or whether they should be reformed and improved. It simply stated that
	"the immediate focus of this document is the Government's intention to legislate at the earliest opportunity to replace CHCs."
	That is really wonderful if one wants open, frank, straightforward and meaningful consultation.
	Before discussion even began, the Government set down what they would do at the end of the process. If the views expressed in the submissions that they received from members of the public, people who have dedicated their lives to working for CHCs, hon. Members on both sides of the House, other organisations inside and outside the NHS and local authorities did not coincide with the criteria in point 1.5 of the consultation document, they were disregarded. That is what the Government have sought to do ever since they introduced their original legislation on the matter.
	My preferred option is for retention, reform and improvement, which is what new clause 2 seeks to provide. It would give the Government a breathing space in which they could make proposals to improve and reform the existing structure. In no way do I support the Government's proposals, because they would not lead to the independent integrity of the complaints procedure and of the organisation for patients remaining intact.
	Unfortunately, I am not confident that the Government are prepared to reconsider at this late stage and to abandon what they have been seeking to use their large majority to ram through Parliament. However, I know that some Labour Members will not be bamboozled into supporting such a Government poodle. When we discuss the other new clauses in the group, it will be interesting to hear the comments of other Members to hear precisely what their proposals intend to do.
	The Government are making a great mistake and they do themselves no credit by sticking rigidly to their plan to ram clause 20 through the House tonight. I only hope that the other place gives careful consideration to the issue and to the comments of Members on both sides of the House. With its expertise and role as a revising Chamber, I hope that the other place will try to bring some common sense to the Government on this issue.

David Hinchliffe: I wish to speak to new clause 5 and to its consequential amendments. It is worth making the point that all three main parties, as well as the Independent Member, have signed up to the new clause and that a number of outside organisations believe that it is the appropriate way forward. We have backing from the Patients Association, the Consumers Association, Age Concern, the Association of Community Health Councils for England and Wales, the Royal College of Nursing and several other important national bodies.
	I shall briefly sum up the purpose of the new clause. I do not wish to speak at length, because the issue has been rehearsed several times in this Parliament, including on Second Reading, and in the last Parliament before the general election.
	I have always been concerned that, since the inception of the national health service in 1948, there has been a lack of sense of ownership of the service by its users. It has been a challenge for successive Governments to address that question, and I am not sure that we have yet come up with a coherent solution. I have always been concerned that there has been a consistent lack of democracy in the NHS, particularly at a local level.
	I have favoured a role for local government and I have been very conscious that the democratic deficit has been maintained by the concern of certain professionals—particularly in the medical profession—to obstruct what they regard as the political control resulting from politicians and elected people asking questions about the direction of the service at a local level.
	Community health councils were advanced in 1974 as the patients' voice. I had the privilege of serving on a CHC from 1974, and was vice-chairman of one for many years before I became a member of the local health authority. It is fair to say that CHCs have had variable success. In some areas, they have done a first-class job in representing the interests of patients but, in others, they have been less effective.
	I do not accept the statement of the hon. Member for West Chelmsford (Mr. Burns) that the Government do not like opposition and that their motivation for removing CHCs is the result of that. I believe that there are sound reasons for re-examining a system that since 1974 has, in some respects, served us quite well but, in others, not as well as it should have done. The time has come for reforms and I support aspects of the direction in which the Government are moving.
	The previous Parliament considered the Health and Social Care Act 2001 and I recognise that it contained a number of positive elements. I certainly commended them at the time. I have always believed in an important role for local government, so I was very happy that the Government came up with the idea of having overview and scrutiny committees based in local authorities. They were given the power to object to key changes in policy, such as closures, and have the statutory function that CHCs have traditionally had.
	I was always concerned that CHCs, as constituted, did not have a democratic mandate. Local authorities have such a mandate and are accountable to the electorate. Therefore, on issues such as closure and change of use, the local democratic system should play a major part and people should be able to express their views.
	I also supported the idea of patient advocacy liaison services—PALS. The revised idea for PALS to be based in trusts to deal with complaints is a good one. I was in my local primary care trust only yesterday and saw the PALS organisation very well signposted. People can go there to seek advice and support, and I welcome that.
	I also supported the proposal for patients forums. My concern was that there would be a need to examine the level above those forums in the local health economy, which is why we had an important debate on patients councils when we considered the Health and Social Care Act 2001. In a sense, we return to that debate tonight.
	I believe that I had an agreement with the Under-Secretary's predecessors in the Department of Health before the election to include some positive elements of CHCs in the new framework. My slight concern, however, was that, when my amendments were discussed in another place, the Minister in the House of Lords gave a somewhat different version of patients councils than I had proposed in the Commons. Hon. Members who had followed the debate recognised that the emphasis was different in the two Houses, which is why it was difficult to get the proposals through the Lords.
	I warmly praise the Under-Secretary's role, because she has gone out of her way to listen to those of us inside the House and elsewhere who have serious concerns. She has worked long and hard to come up with a solution that will come as near as possible to meeting my concerns and those of other hon. Members. It has been a pleasure to work with her, because she has genuinely tried very hard to find a solution. We are inches apart, but those inches are extremely important. Therefore, I wish to expand on the issues on which there is a slight difference between us.
	The positive changes in the Bill include the creation of the Commission for Patient and Public Involvement in Health. I spoke at length to my hon. Friend about this issue last summer and I recognise that she has a passionate concern to engage in the health service disadvantaged groups and those who never had a say about their local health care. As she knows, I occasionally visit her constituency to watch rugby league and I am aware of the problems that it faces. I know that she wishes to engage in the health service people who were not previously involved in any way.
	I welcome the fact that the commission will have an enabling role, will be involved in developing a public voice and will be concerned with those who have no voice. In the last Parliament, I made the point that the main users of the NHS in my area were young women with children, and they have no voice. The main users are not engaged with the health service in any way. I recognise the need to encourage that involvement and to listen to people with first-hand experience of the problems that they face.
	I welcome my hon. Friend's proposal for a common badging system—I hope that it is taken a stage further. If we have a symbol that is known nationally and locally, people will know where to go to have their voice heard in the NHS. That idea could extend to advocacy.
	I shall briefly list my key concerns about the Government's proposals. I am worried that the system is too complex and that many people will not understand it. I mentioned on Second Reading that I did not fully understand it. Although I now have a better idea of what the Minister is trying to achieve, I still believe that the system is over-complex and that it needs to be simplified.
	The fragmentation of the separate patients forums also concerns me. They will focus on the individual work of their trusts and, as I said in a debate in the last Parliament, we need to look beyond that because it is too narrow. I am also worried about the lack of independent back-up and support for patients forums. They may well have to rely on the trusts that they are deemed responsible for monitoring.
	In the last Parliament, the Health Committee examined adverse incidents in the NHS and the complaints system. In respect of serious complaints, it thought that independent advocacy, which is a stage beyond the PALS role, should be based within the CHCs. The patients councils that I propose should also have a role in the structure, and the monitoring and scrutiny of forums should be linked to the advocacy function.
	New clause 5 and consequential amendments would ensure that patients councils were included in the Bill and that they were made up of forum members so that they offered an overview of local health issues, because that is lacking. I accept that the Minister made it clear that she expects the commission's local networks to do that job, but members of patients councils of individual forums need to be able to get together to look across the local health economy. The Government do not propose that, although I think that my hon. Friend said that it will be encouraged.
	I want patients councils to be serviced by the commission's local network. The secretariats would comprise the commission's local networkers so that national standards are linked to the local priorities set by patients councils, which are close to the grass roots and patients' concerns.
	Finally, the Health Committee envisaged basing the advocacy function within patients councils, which would give a consistent and easily identifiable base for that work. I hope that the badging system can be applied to that so that people are clear about where they need to go when they have serious problems.
	I do not want to say much more because we have rehearsed these arguments several times and most hon. Members are well aware of the issues. I hope that my proposal would provide a unifying structure of lay people at the level of the local health economy, offering an overview of that economy that is lacking in the Bill. My hon. Friend the Minister implied that she will try to bring that about by regulation. I am afraid that I have been in this place long enough to have heard similar offers by numerous Ministers in different Governments. This is not meant as any disrespect to her, but I want that provision written into the Bill. I hope that even at this late stage the Government will accept my proposal.

Evan Harris: I agree with what the hon. Member for Wakefield (Mr. Hinchliffe) said about the Minister's conduct. She has always been available to listen to the multiple objections to her proposals. It is just as well she is a listening Minister, because otherwise we would be even more frustrated.
	I also agree with everything else that the hon. Gentleman said, and I shall not cover the same ground except to point out, as I think he would recognise, that we have discussed this before. During the passage of the Health and Social Care Act 2001, my hon. Friend the Member for North Devon (Nick Harvey) stood where I am now and moved a similar amendment or new clause before the Bill went to the House of Lords and the proposal ran out of time. I hope that we do not have to go as far this time and that the Minister will find a way to recognise that the proposal in new clause 5, which has also been tabled by the Liberal Democrats, is a compromise. Some people would have preferred community health councils to be reformed rather than abolished.
	New clause 2 would have an effect similar to a proposal that we debated in Committee which sought to reform community health councils to take account of what the Government describe as the new NHS. We wanted to ensure that they had the functions and membership that Ministers, in many cases correctly, thought would be necessary to interact with the new NHS. The Minister rebutted or objected to our suggestions even more firmly than we argued them. New clause 2 is an attempt to persuade the Government to reform community health councils.
	The Liberal Democrat party, which moved a similar amendment in Committee, supports the thrust of new clause 2, but we are also willing to put our names to an amendment that would go further. The advantage of new clause 5 is that it creates a structure for patients forums to interact in. Its functional approach places the roles of co-ordination and advocacy—advocacy in terms of changes to the local health service, not as defined in other parts of the Bill—at the level of overview and scrutiny committees. That will be of mutual benefit to patients forums that want to ensure that they have adequate mechanisms and structures to feed in opinions to the overview and scrutiny committees. It will also be of significant benefit to local authority overview and scrutiny committees to have patients councils that broadly cover the same area. They will be a single, effective and empowering channel—I am surprised to use the word "empowering"; I usually try to avoid it—for the concerns of patients and the public to be brought to the attention of the overview and scrutiny committees.
	I join the hon. Member for Wakefield in thanking the Association of Community Health Councils for England and Wales. I also thank London Health Link. Not only did they provide advice on how our amendments and new clauses should be framed, but they recognised that things have to change. The Minister should at least concede that we are no longer fighting the principle of whether there should be patients forums. To an extent, if one accepts new clause 5, one accepts the abolition of CHCs. Those bodies have shown a willingness to meet the Government more than half way, because all the other structures that the Government propose will be in place. The framework is sensible. It is in tune with what the Government sometimes claim they want for the local networks. It is possible for us to rally around the framework and improve it.
	I turn now to other new clauses and amendments in my name and those of my hon. Friends. New clause 7 seeks to insert in the Health and Social Care Act 2001 a duty to consult. That duty would fall not only on strategic health authorities, PCTs and trusts but on the Secretary of State, or rather on bodies that function at a higher level than strategic health authorities and to which the Secretary of State could delegate the duty. I am concerned about bodies such as the national strategic commissioning advisory group, or NSCAG, and the regional specialist commissioning groups, which have a significant input into health service policy. They make recommendations and proposals for changes to significant areas of care, such as heart and lung services at a national level and paediatric intensive care at a regional level. If we are to have a complete consultation system, the necessary mechanisms must be in place.
	The Government feel that the new clause is not necessary because strategic health authorities have a duty to consult and some of those supra-strategic health authority bodies will be made up of strategic health authorities. One of those may act as the lead authority and will therefore have the duty, the time and the personnel to consult all the patients forums and relevant groups in the area. However, it is questionable whether those circumstances will always pertain. Certainly it is hard to see how there would be a lead authority for consultation on a decision made by NSCAG or even by a regional specialist group. The Minister should state clearly that there will be no gap in the procedure, or she should accept the new clause.
	New clause 8 is important because it would close an existing loophole. Those of us who carefully followed the proceedings on this Bill and on the Health and Social Care Bill will know that the important power of referral to the Secretary of State is currently exercised by community health councils, which are to be abolished. That function has not been given to patients forums, so we must ask which body will have the power to refer to the Secretary of State significant issues such as the failure of consultation or concerns about decisions made following consultation.
	We have been assured that the function will be performed by the overview and scrutiny committees, but it is unclear whether the committees have that power, and it is important that the position be made clear. New clause 8 would do so—there is no disagreement about that—but I hope that the Minister will advise us as to whether the power exists. If she wants to resist the new clause, it would be nice if that advice were made available in written form. One would have hoped for it to be available before we had to decide whether to press the new clause, but the Bill has other parliamentary stages to come.
	I may be able to explain amendment (a) to Government amendment No. 33 in interventions when the Minister is speaking to amendment No. 33. It makes a concession, which we requested in Committee, that patients forums will have the power to refer to the overview and scrutiny committee anything that they feel needs to be considered. Our amendment seeks to make it clear that the overview and scrutiny committee would have a duty to respond to that referral.
	The Government say that they are reluctant to impose duties on local councils—indeed, they say that it is their policy not to do so—but that will come as a surprise to councils throughout the country. On such an important issue, where responsibility for consideration, oversight and scrutiny of health service changes is, in a welcome move, being shifted to local authorities, overview and scrutiny committees should have a duty to respond to patients forums. They should not necessarily have to take on all their concerns, but they should at least have to consider the issues. I hope that the Minister will ensure that that occurs.
	There are many other amendments in this group, but I hope that the Minister will allow me to intervene to clarify the purpose of some of the Government amendments. In conclusion, I am determined to support the proposals, on which I took the lead in Committee, to reform community health councils because they are a tried and tested model, so I shall support new clause 2.
	I am, however, much more optimistic that new clause 5 will secure support from hon. Members on both sides of the House, including the Government. I hope that we will find a way to ensure that the best of the Government's proposals are combined with the best ideas of the community health councils and of hon. Members of all parties to form an effective organisation, an effective structure and, most importantly, an effective function. We must ensure that the NHS is subject to the scrutiny and input of patients and the public.

Stephen Hesford: I was unable to serve on the Standing Committee as I was a member of another Committee, so I rise to make points that I would have made in Committee if I had been present.
	I always listen with great care to my hon. Friend the Member for Wakefield (Mr. Hinchliffe), but I cannot support new clause 5, which is a compromise. Neither can I support new clause 2. I served on a community health council for four years in the early 1990s, and I was a vice-chair in Manchester, just around the corner from my hon. Friend. It is unfair in the extreme of the hon. Member for West Chelmsford (Mr. Burns) to chide the Minister about the fact that nothing can change. The fact that someone has served on a community health council does not prevent them from seeing it in its true light. As the hon. Gentleman said, community health councils were set up in 1974, and times have changed. If he will forgive me for saying so, new clause 2 is opportunistic and backward-looking. It does not deal with the fact that substantial reform is necessary, as many hon. Members have come to realise.

Simon Burns: Absolutely: reform is necessary.

Stephen Hesford: Does the hon. Gentleman want to intervene?

Simon Burns: The whole point of my argument is that reform is necessary. If the system does not seem to be working as well as it should, the Government should reform it, not abolish it.

Stephen Hesford: It is political opportunism to take that backward-looking view. Confusion reigns because, interestingly, the hon. Member for Macclesfield (Mr. Winterton), who has put his name to new clause 2, has also put his name to new clause 5. He cannot have it both ways.

Peter Atkinson: Perhaps I can enlighten the hon. Gentleman as to why my hon. Friend the Member for Macclesfield (Mr. Winterton) has signed his name to both new clauses. He made it clear that he supported new clause 2, but as it is unlikely to succeed he supported new clause 5 as a second option. That is perfectly logical.

Stephen Hesford: I hear what the hon. Gentleman says, and I credit him for supporting his absent colleague, but I am afraid that he has not dealt with the illogicality of the position adopted by the hon. Member for Macclesfield.
	I must tell my hon. Friend the Member for Wakefield that new clause 5 is over-fussy, over-lengthy and shares with new clause 2 the problem of not grasping the nettle that the Government have grasped in introducing the reform of community health councils. Both new clauses seek a delay.

Evan Harris: The hon. Gentleman described new clause 5 as over-lengthy. To avoid comparisons with a certain king and accusations of having too many notes, perhaps he will say which bits of it are redundant to achieving the purpose sought by the change. Or does he think that there is a limit to the length of new clauses that hon. Members should introduce in principle?

Stephen Hesford: I am afraid that I shall not go down that road—[Interruption.] No, no.
	The strong support that my hon. Friend the Member for Wakefield received from Liberal Democrats shows that, in effect, his new clause has not grasped the issue; it is a compromise too far. The Bill is not the same as the one that came before the House in the last Parliament. I commend my hon. Friend's tribute to the Under- Secretary, my hon. Friend the Member for Salford (Ms Blears), who has indeed clearly listened. The Government have travelled a long way on reform; I urge the House to accept that she and the Government have travelled far enough. Some problems that were rightly identified have now been addressed. The Commission for Patient and Public Involvement in Health, for example, is a valuable addition.
	I know that other Members want to participate in our debate so, to conclude, I will say only that new clauses 2 and 5 seek delay; they do not get to grips with the problem. The Government were right to introduce their proposals and I urge the House to reject both new clauses.

Richard Taylor: I, too, pay tribute to the Parliamentary Under-Secretary. As I have said before in the House, she has written that the views of citizens will be valued,
	"'listened to and acted upon'".—[Official Report, 8 November 2001; Vol. 374, c. 468.]
	I find myself in a similar position to the hon. Member for Macclesfield (Mr. Winterton)'s. If I had thought there was any chance of new clause 2 being accepted, I would have put my name to it. The compromise in new clause 5 is much more realistic and would allow us to take on and support some of the changes that the Government are making.
	Why abolish community health councils? That question has never yet been answered. The hon. Member for Wakefield (Mr. Hinchliffe) takes a charitable view which, I am sure, is right. CHCs have achieved patchy success, are variable and could certainly be improved. The hon. Member for West Chelmsford (Mr. Burns) takes a more powerful view, which I share; in some instances, CHCs have been a thorn in the side of the Government. I know that only too well; my own CHC, of which I was a member at the time, had the resources to take the local health authority to judicial review. What did civil servants do locally? A high-powered officer of the NHS executive in the west midlands came to visit the little Kidderminster and District CHC, threatening that if it took the local health authority to court, that could cost it £220,000 to £250,000. The local CHC was sufficiently strong-minded not to bow to that threat.
	I should like to explore a little more what we shall lose when we lose CHCs. At the moment, we have a thoroughly independent voice—an independent citizens' watchdog. I am deeply suspicious of the Secretary of State's attempts to establish independent bodies. To get him out of reviewing and making the final decision on hospital reconfigurations, we now have an "independent" reconfiguration panel. It is too early to know how independent it is. On the other hand, we already have an independent NHS Appointments Commission. This week, the Health Service Journal shows that it has appointed the 28 chairs of strategic health authorities, 24 of whom are already trust or authority chairs. Remarkably, 17 of them are health authority chairs who will be out of a job on 1 April. However, 24 of those 28 appointments were previously made by the Secretary of State and have just been rubber-stamped by the independent commission.
	We are also losing a one-stop shop. I should like to illustrate that with an example from Worcestershire. The hon. Member for Wakefield implied that there will be a difficulty. In Worcestershire, we have three CHCs, conveniently situated in the major conurbations. We shall have six forums—I should love to know whether the plural is forums or fora—because we have three primary care trusts, a county-wide acute hospital trust, and an ambulance trust, and we shall have a mental health trust. Because the PCTs are sharing out health authority functions, one can see that a single patient might need to consult or take advice from three, possibly four, patients forums. That is the strongest reason for having a drawing-together body. The patients council, as suggested in new clause 5, appears to be a body that could draw together functions and situations, making it easier for individual citizens to express their concerns.
	To conclude, as I have already said, I would much rather that CHCs were reviewed and strengthened, as is the case with Wales and with the equivalent of CHCs in Scotland. However, I have been in the House long enough to begin to realise what is possible and what is not. New clause 5, which would establish patients councils, appears to offer the chance of retaining independence and bringing organisations together within the overall framework of the Bill, so I commend it to the House.

Patrick Hall: I should like to comment on the context of new clause 5, which seeks to co-ordinate and integrate locally a replacement system for community health councils. I am tempted, but shall not go down the road of trying to summarise what has happened since July 2000, when the abolition of CHCs was first announced in the NHS plan. We have come a long way since then; much time has been spent trying to understand a replacement structure and system that, for too long, was over-complex and unclear.
	After last year's general election, and notably in the Government's response to the listening exercise, which was led by my hon. Friend the Under-Secretary, we got to a point where we recognised that the fragmentation that had characterised previous thinking was unsatisfactory. The essential functions were integration; co-ordination; and informing and supporting patients forums, patient advocacy liaison services and local authority overview and scrutiny committees. The Government agreed with my hon. Friend the Member for Wakefield (Mr. Hinchliffe) who, in an amendment tabled last May, tried to pull all those functions together in patients councils. They all seemed to be accepted, clarified, fully retained and acknowledged in the Government document published last September in response to the listening exercise. The only difference was that the Government did not want to call the new way forward patients councils. That is okay by me. The Government have described what they want to see put in place as patients councils plus. Fine. The intention was clear. Many of us who have considered these matters with some concern were reassured.
	However, the Bill does no more than provide a framework. Many of the matters about which there are concerns in the House and outside will not be clarified until regulations are published. That is the problem. I suggested on Second Reading that perhaps draft regulations could be published during the Committee stage, to give people an idea of how the picture would emerge. We need to see how the mechanism might operate. I want it to work, and I know that the Government do as well. My suggestion was not taken up, but that is up to the Government.
	I do not know for sure how the integration and support function of the Commission for Patient and Public Involvement in Health, through its local networks, working with lay reference groups and operating local outreach teams, will work. The intentions are clear, as I have acknowledged, but the mechanism has not yet been clarified sufficiently. We need some examples of how the local networks will work and the sort of geographical area that they will cover. It has been flagged up that they should be at PCT level, but that needs to be confirmed. I know that the Government do not wish to be prescriptive. I understand that, but the danger then is that we are too vague and we cannot see the picture, yet here we are, deciding on legislation tonight. We need to know also about the resourcing of the local networks of the commission, and about the staffing.

Evan Harris: I am listening closely to the hon. Gentleman's thoughtful contribution. I know that he is asking questions about what the area should be, but whether it is patient councils or local networks coming from on high in the commission, does he accept that there is a strong argument for ensuring that the area is generally the area covered by the relevant overview and scrutiny committee, to enable co-ordination with the scrutiny function?

Patrick Hall: That should be the largest geographical area covered by the replacement co-ordinating body. I have some questions about that, but I shall not take up the time of the House. That proposal would be logical, but in some instances the area covered might be too big. Communities do not necessarily fall entirely into one county council area, for example. It may be necessary to split that into smaller areas. I would certainly argue for that in the case of Bedfordshire, but I did not intend to bring that into the debate, as I do not want to complicate it. The matter has been far too complicated, and for far too long. We need to come to some clear conclusions, preferably today, and not wait for the other place to deal with it.
	I understood that the local networks would be established to carry out the local overview, co-ordination, support and integration work that many of us said was missing a few months ago. The Government acknowledged that and brought those functions back in. However, I am now not sure about that. I understand that the Government intend to create a locally based collective voice of patients forums, which could well be another body, in addition to the network—another body that will need to be resourced in order to function. That is the impression that I got from the briefing that was made available. It states that in black and white.
	I understand that it is intended that the additional body that will be the collective voice of the patients forums will be underpinned by legislation, forcing patients forums to work together and forcing the networks and the wider commission to listen to the outcome of the deliberations of the patients forums. My questions are intended to be helpful and constructive, and to tease out these matters so that we can be clear and move on. I am not clear about the matter, and I have tried to follow it over recent months. The Government have had plenty of opportunity to remove all doubts, but I still have serious doubts.
	New clause 5 has the advantage, at least, of being robust and clear. It provides a simple mechanism, which, last autumn, I thought that the local networks would fulfil. If that is the case, let me be persuaded. If my hon. Friend the Under-Secretary is to respond to this part of the debate, and if she does not want the House to accept new clause 5, she will have to explain clearly why. She will need to describe how the system will work and give an example of how it will work on the ground somewhere; otherwise these matters will continue to confuse. If we are confused at this stage in the legislative process, that could make matters far worse months and years down the line. We need the plan to work on the ground, with real people. It is time for us to move on to a better system. I urge my hon. Friend to help us to do that.

Peter Atkinson: I am grateful for the opportunity to follow the hon. Member for Bedford (Mr. Hall) in our short debate. He has made well a number of important points that have been worrying people, including members of the community health council in my constituency. We are moving into unknown territory, and at this late stage of the Bill, we still do not have answers to those questions. The hon. Member for Wyre Forest (Dr. Taylor) asked the most cogent question—why the Government are proposing such a system. We have had no proper explanation of why we need such a complicated change. I hope that at this late hour we will get an explanation from the Minister.
	Rather more years ago than I care to remember, I used to be a member of something called an area health authority. Those were abolished, but seem to be coming back in a slightly different guise, called a strategic health authority. I remember only too well how our hearts sank when members of the community health council rose to speak. They were a thorn in our side. They discharged their job extremely effectively, and after a time we began to respect them for the way that they worked and their dedication to their job.
	It is true that not all CHCs are perfect. Some were undoubtedly poor. My hon. Friend the Member for West Chelmsford (Mr. Burns) made our position clear. We are not against change. The hon. Member for Wirral, West (Stephen Hesford) seemed to think that we were going backwards and arguing for the status quo. We are not doing that. We argue that we should build on a good foundation, which the community health councils provide. Let us make changes, rather than throwing them all out.
	The patients will be left with a confusing plethora of patients forums. In Northumberland we are to have one primary care trust, but in County Durham, for example, there are to be six PCTs, and each one will presumably have a patients forum. We will have an ambulance trust and a mental health trust, and I understand that the county council and the NHS are getting together to provide a community care trust, which will take over the functions of the social services department and merge them into one trust.
	Even now it is hard enough to involve patients in the affairs of the NHS. The attitude still prevails that treatment from the health service is some sort of privilege, and that one should be grateful to be seen by a doctor. Increasingly, patients know that if they have a complaint, they can turn to the community health council. Citizens advice bureaux and others will point them in that direction, but patients will have great difficulty in finding their way through the maze to the appropriate patients forum.

Stephen Hesford: Is not one of the strengths of the new system its location in the places that patients use? One of the downsides of the old system—perhaps the hon. Gentleman and other hon. Members share my experience in this respect—is that if we were to go into the street now and ask a British citizen whether they had heard of a community health council, they would say no. [Interruption.] That is my overwhelming experience. People have not heard of CHCs after almost 30 years.

Peter Atkinson: I take the hon. Gentleman's point, but I must disagree. There is more chance of people finding community health councils than patients forums. If he thinks that the system would be improved by placing representatives in the major hospitals, ambulance stations or wherever else, the community health councils can consider that proposal. As we are proposing to reform CHCs, the suggestion is certainly worth discussing. I do not rule it out, but I must restate my view that we will lose a great deal by abolishing CHCs, which are independent and can build up a considerable body of expertise over the years. They know the health service in the areas that they serve, but we will lose that expertise, which is a great pity.
	Northumberland community health council, which serves my area, has written asking me to support new clause 5 if the Opposition's proposal fails. It points out that it has dealt in the past 12 months with complaints about the health service from 178 patients in the county. That shows how much good work it does. The health service is going through another revolution as a result of the Bill and other legislation, so it is completely daft to abolish the patients organisation when it will probably be most needed and to introduce a new system that is untried and unclear at a vital time for the health service.
	I want briefly to speak to amendment No. 73, which stands in my name and relates to patients forums and their power. We had a small debate in Committee about the matter with which it deals. My concern is that the patients forums are being given extreme power. In particular, they are given the right of entry into premises. All of us need to be guardians of our freedom. In that context, I cannot see any reason why members of a patients forum should have a compulsory right of access to health service premises, including the surgeries of doctors and pharmacists. My constituency has doctors and pharmacists who work as sole practitioners and operate from their homes. The pharmacists live above the shop, so to speak. The powers in the Bill give patients forums a right of entry into such premises. My amendment seeks to specify that the power should not extend to the living quarters of doctors and pharmacists and I hope that the Minister will be reasonably helpful in that regard.
	I cannot see any reason why patients forums should have such powers and I would be grateful for some explanation. Can the Minister imagine a doctor saying "In no circumstances can you come into my surgery" to members of patients forums who are seeking an appointment to make a visit? In the rare event of that happening, the Commission for Health Improvement could use its powers of entry. Surely that is sufficient.

Lynne Jones: Surely, patients forums should have access to areas to which patients themselves have access.

Peter Atkinson: Yes, but they should not have compulsory powers. I am sure that the hon. Lady cannot imagine why they would need the powers. Why do they need a right of entry? It is inconceivable that a hospital or any other health body would say "You can't come in" to a patients forum. Why must we give patients forums draconian powers, giving lay people a right to rummage through the private possessions of a doctor or pharmacist? The hon. Lady shakes her head, but it is true. The powers in clause 16, which deals with entry and inspection of premises, allow the Secretary of State to make regulations giving the right and power of entry. We need to be aware of people's civil liberties. As I said, if entry is refused, the Commission for Health Improvement, which has the appropriate powers, can enter the premises if it is believed that something serious is happening.
	I hope that the Minister will consider amendment No. 73, as I think that Parliament has a right to protect the rights of individuals. They have been sorely hammered in recent months, and this is one occasion when we could avoid hammering them even more.

Andrew Murrison: The hon. Member for Wirral, West (Stephen Hesford) inadvertently made a very good point in his intervention on my hon. Friend the Member for Hexham (Mr. Atkinson). He suggested that, in his constituency, if one asked a person in the street about their CHC, they would not know anything about it. In my constituency, people would know about their CHC.

Stephen Hesford: I said that we would get that answer if we were to walk outside now and speak to people in the street. I do not represent Cities of London and Westminster.

Andrew Murrison: I am grateful for that correction, but I think that the meaning was clear. In Westbury, people know all about their CHC. The point is that there are differences in practice throughout the country. There are good CHCs and some that are not quite so good, but the fact that they are good means that they are a good basis on which to build and reform. That is the thrust of the Opposition's argument about CHCs.
	Bath and District CHC monitors health care services provided by two health authorities, two ambulance NHS trusts, two acute hospital trusts, a mental health partnership trust, two PCTs and a PCG. When my constituents are poorly, many of them—especially the vulnerable and elderly—end up dealing with local NHS services that are provided by two or more trusts. None the less, however many trusts they use, in their view, they are using the national health service in a fairly seamless fashion. My CHC centres its work on ensuring that patients receive the very best seamless provision of quality health services as they navigate their way around the multiple tiers of the national health service. Seamlessness is one of its strengths, but a strength that the Bill threatens.
	The Association of Community Health Councils is, understandably, rather hurt and upset. Indeed, it is bewildered. It said:
	"The proposed alternatives to CHCs as set out in the Bill fall far short of meeting the widespread concerns about the independence of the new bodies and their lack of integration. If the Secretary of State pushes ahead with this bill in its current form patients will lose a respected, effective, independent health Watchdog and in its place they will get a system that is more fragmented, more confusing to the public and less independent."
	CHCs are certainly watchdogs, but what we have been offered in their place is poodles, and lots of them: oodles of poodles, in confusing myriad PALS and patients forums. The proposals made by the hon. Member for Wakefield (Mr. Hinchliffe) in new clause 5 are interesting, but they are second best. They suggest that we should keep our poodles and merely have something that might turn out to be a watchdog.
	That brings us to cost. Despite the advice of the Opposition, the Government have set their face against building on the CHC model. My CHC costs £118,664, but its chief officer estimates that it will cost £750,000 to provide PALS alone. Indeed, the current edition of the Health Service Journal suggests that it will cost 10 times the amount spent on CHCs to provide the new services outlined in the Bill.
	Roy Carr-Hill, professor of medical and social statistics at York said of the new system:
	"We're going to end up spending all the possible savings from Shifting the Balance of Power and it's still unclear how effective this . . . will be."
	We should ask not only about the source of the money and the opportunity costs involved, but where the Government suppose that the army of volunteers required for staffing will come from. Those of us who have been heavily involved in the voluntary sector know that it has become increasingly difficult to get people, especially those with the right skills, to commit themselves for nothing. If public enthusiasm for the Bill is anything to go by, it seems unlikely that folk will queue up to lend their services to PALS and patient forums.
	I am sure that my CHC's plea for a more integrated approach is echoed throughout the country. Patients, who view the NHS as a whole, not in little bits, would thus have a one-stop shop for their anxieties and representations. Conservative Members believe that reforming CHCs, not abolishing them, is the way ahead. If that is beyond the Government, can we place a duty on trusts to ensure that their poodles in a geographical area at least talk or bark to one another? Surely there is scope for sharing financial and human resources, thus driving down the appalling costs that informed opinion has forecast for the proposals, and making the best use of finite voluntary effort.

John Baron: The Bill would abolish CHCs in England without replacing them with any community-led overview of the local NHS. England would be the only part of the United Kingdom without CHCs or a similar body. The measure proposes a confusing array of new mechanisms, which would make it more difficult for people to understand the system, influence the local NHS or obtain independent help when they needed it.
	The proposed new system is difficult to understand because it is so fragmented and complex. The Bill proposes overlapping and separate organisations, which may serve only to confuse patients and the public. Without clarification from the start, there is a danger that much energy will be diverted into sterile competition as different organisations jockey for position in their local communities. That would be a complete waste of resources and energy. Elizabeth Manero, the chair of London Health Link, warned that the proposed system would be "a charter for tokenism". She said that it was "fragmented" and did not comply with recommendations from the Bristol inquiry for fully independent bodies.
	Individual patients forums would have a remit for considering only their trust's services, with no formal mechanism for coming together to provide an informed overview of the local NHS from the patients and the public's perspective. Patients forums would be run entirely by volunteers and have no paid staff. I imagine that they would seek support from a separate body of paid staff—the Commission for Patient and Public Involvement in Health—or that they may be forced to rely on help from the trust that they monitor. That would compromise their ability to be an effective and independent watchdog.
	People who require independent help with problems with the NHS or complaints would have to approach other organisations, for example, the independent complaints advocacy service. Separate organisations make up ICAS, and it would therefore be more difficult to scrutinise and monitor complaints as they were processed. Staff of the Commission for Patient and Public Involvement in Health would be tied up in the bureaucratic exercise of tendering, monitoring and evaluating ICAS.
	I have two further anxieties. First, the Bill removes the requirement to consult about changes to functions and boundaries of key NHS organisations, such as strategic health authorities, PCTs and NHS trusts. Community health councils must currently be consulted on such changes. The Bill does not specify the organisation that will take on that function. That is worrying.
	Secondly, the new structures will be much more expensive than CHCs. It is proposed to abolish CHCs without any guarantee that sufficient funding will be made available to ensure that their replacements are properly resourced. Again, that is worrying. Community health councils should be given more time to reform. They have had faults in the past, but, overall, they have championed patients by monitoring the health care in their local communities. They should be given more time to reform and I therefore support new clause 2.

David Amess: I support new clauses 2 and 5. The hon. Member for Wyre Forest (Dr. Taylor) is not naive, but I have observed him on the Select Committee on Health, and he is a gentleman in every sense. He asked the Minister why CHCs should be abolished; perhaps I can help him. The Government dislike any criticism, and they are especially upset about criticism from Labour supporters. When Labour Members were in opposition, they loved CHCs because they were critical of the Conservative Government. Now we have a rotten Labour Government, and they cannot abide criticism from CHCs, especially from Labour activists.
	The Under-Secretary who will reply to the debate has been a great champion of CHCs. The hon. Members for Wakefield (Mr. Hinchliffe) and for Bedford (Mr. Hall) also have an honourable record in consistently championing the cause of CHCs. However, there is no doubt that what we are being offered as a replacement will not do. The proposals are ill thought out and shambolic.
	If CHCs continued to exist, they would champion the cause of one of my constituents, a lady, who was diagnosed with lung cancer eight weeks ago. The cancer is operable, but she has been waiting eight weeks for an operation. The cancer is pressing on the spine but nothing has been done because of delays. Southend community health council will take up the lady's cause. As her Member of Parliament, I am doing everything that I can. I have tried to talk to the bed manager, who was on holiday for a week. No one was in charge during that time. When we spoke to the person today, we were told that further time was needed to examine the matter. Southend community health council is disgusted by the fact that my constituent has had to wait eight weeks. Her family are distraught about the circumstances, and they will not forgive the Government unless something happens.
	I have received a letter from Southend community health council, as my hon. Friend the Member for Hexham (Mr. Atkinson) said, which expresses its anxieties about the Government's plans. Community health councils are enthusiastic about changes that benefit patients and the public. They do not claim that there should be no change. They are certainly not arguing for the status quo.
	CHCs have been an effective independent watchdog in the NHS for the past 27 years. In that time, Southend community health council has helped thousands of people. The hon. Member for Wirral, West (Stephen Hesford) said that people in his constituency had not heard of CHCs. I am surprised at that. In my area, and those of most other hon. Members, if people had not heard of CHCs before the current campaign, they jolly well have now. People probably took them for granted, but now they are clutching at this precious commodity, and saying that what is being offered in its place will not do.
	The new proposals threaten to eliminate the only effective, integrated independent watchdog that patients have, without putting forward an adequate replacement. The letter that I received from Southend community health council states:
	"In the wake of recent scandals, such as Shipman, Ledward and the fiddling of waiting lists, this seems particularly ill advised."
	It goes on to say that the proposals with which the Minister will probably try to seduce the House shortly are
	"fragmented and confusing . . . without a unifying community-led element at local health economy level."
	The Government, when they were in opposition, never turned away from using any briefing from the British Medical Association. For 18 years, the BMA was the Labour party's watchdog. However, since 1997, we never hear the Government say a word of good about the BMA. All hon. Members will have received a briefing from the association, stating how disappointed it is with the proposals.
	The Secretary of State for Health put his foot in it in a big way today. Those of us who witnessed what happened during the private notice question and heard not one "Hear hear" from the Government Benches saw his proposals go down like a lead balloon. Today, the Labour Government are privatising the national health service. There can be no doubt about that. It has taken a Labour Government to do so. A number of hon. Members who sit on the Select Committee on Health are present in the Chamber now. When the Secretary of State came before us last week to give evidence on the private health sector, not a word was mentioned about these extraordinary proposals when we questioned him.
	The right hon. Member for Holborn and St. Pancras (Mr. Dobson) was obviously extremely upset about the proposals earlier, and I think that says it all. No doubt we shall hear from the Labour party in the weeks ahead about its plans to charge for all sorts of services that have traditionally been free under the national health service. It is not too late for the Government to admit that they are wrong about abolishing community health councils, to rethink their proposals, and to accept new clauses 2 and 5. If they did that, the hon. Member for Southend, West and the whole of the country would think far more of the Government than they do at the moment.

Hazel Blears: Following the last contribution, I will try to bring us back down to earth, and closer to reality and to the clauses that we are discussing. I want to deal with new clause 2 and the consequential amendments and then new clause 5. Obviously, many of the same issues are involved in both new clauses.
	I reject absolutely the idea that this is a vindictive or pernicious attempt to attack community health councils, as has been alleged by the hon. Member for West Chelmsford (Mr. Burns). He knows very well that, in Committee, I put on record on three or four occasions my personal tribute to the excellent work carried out by many community health councils up and down the land. That stems partly from my own experience, and also from my fairly detailed knowledge of the work that has been carried out over many years by staff in CHCs and, crucially, by volunteer members who have given of their time unstintingly to try to improve the health service.
	That is not to say that realistic, down-to-earth, grounded people do not recognise the limitations of those organisations. Many such people want actively to embrace change and to consider new ways of working; they have the courage to examine new forms of organisation that can strengthen the patients voice.

Simon Burns: Will the Minister tell the House how many members of community health councils in England wrote to the Department of Health, following the consultation process, saying that they wanted the CHCs to be abolished?

Hazel Blears: I have already spoken in detail to the hon. Gentleman about Wirral CHC. He knows that extremely well.

Evan Harris: It was Wigan.

Hazel Blears: It was not Wigan, it was Wirral. That CHC has welcomed the proposals. Many members of CHCs have been in touch with me, either in writing or in person. Many came to the nine regional listening events that were held up and down the country, and broadly welcomed many of the proposals. Yes, they had concerns, but they were willing—unlike some intransigent, inflexible Conservative Members—to embrace change and to consider new ways of working that could help to strengthen the voice of patients and the public in the system.
	Our new system aims to be more accessible, accountable, independent, robust and effective. We are not starting from scratch. We have genuinely tried to build on the best of the existing work being done in public and patient involvement. That involves not only CHCs. We must not forget that a whole range of patient organisations has been involved in this work for many years. There is a tendency to think that public and patient involvement involves only CHCs. The process that we have undertaken over the past few months has enabled many organisations to get more involved and to see how they can make a more effective contribution in future.
	The current system of CHCs has been in place for about 27 years. Inevitably, any change will encounter resistance and uncertainty, and people will cleave to what they know because they do not know what the new system will look like. I acknowledge that there has been a need for the Government to try to explain the changes. Certainly, over the past seven months, I have been out and about with other Ministers and officials from the Department, talking to people in local communities to ensure that we get our vision of a more effective, independent, integrated system across to them.
	Only last Thursday, I spent three and a half hours meeting representatives of the Association of Community Health Councils for England and Wales. We agreed at the end of the meeting, as my hon. Friend the Member for Wakefield (Mr. Hinchliffe) said, that we were only inches apart in terms of the things that we wanted to do. We made many changes during the listening exercise and as a response to the listening document. We showed that we had not just listened; we had not just heard what people said, we had acted on it as well. This was not a sham process, an empty attempt at consultation. This was real, engaged activity. We were prepared to listen and to act.
	There is broad consensus about the functions of the new system. The functions of the new commission have been broadly welcomed. There is also consensus about the need to involve people who traditionally have not had a say in the health service—people in excluded and marginalised communities who have been ignored for many years when services have been shaped, developed and drawn up. There is a willingness in the field to draw in a wide range of individuals and groups, and to make sure that their voices are right at the centre of shaping services for patients.
	The consultation process has been an extremely good one, and that is not just my view. I draw to the attention of hon. Members a letter circulated by the Long-Term Medical Conditions Alliance. The alliance represents the Alzheimer's Association, the British Cardiac Patients Association, the National Schizophrenia Fellowship, all long-standing, respected patients' organisations. They welcome the new proposals, and state, quite realistically, that
	"bearing in mind the impossibility of accommodating everybody's wishes in their entirety, the key concerns raised during"
	the consultation
	"have been addressed in the latest set of proposals."
	They welcome the initiatives in the Bill, specifically the local networks, which will enable the commission to bring together patients forums to build capacity for involvement in the community. They say:
	"We believe that the proposals contained in the Bill will allow diversity to develop, and that any amendment involving yet more committees (such as the Patients' Councils"
	in new clause 5
	"would lead to the strangling of genuine citizen involvement and the promotion of bureaucracy at the expense of the voice of individual users of the NHS."
	I want to deal with that point in particular.

Lynne Jones: I have read the LMCA letter, but those bodies represent people with long-term medical conditions who are regularly engaged with medical services. Patients forums are therefore much more likely to involve patients who take a long-term interest in them. Those with acute conditions go in and out of the system. With respect, the view of those organisations is not necessarily representative of patients as a whole.

Hazel Blears: I would not say that that is the view of all patients, but it is extremely important, given which organisations are members of the alliance, and it shows that widespread support exists.

Evan Harris: If we are trading organisations, the Minister may be aware of the view of the Patients Association, which has at least as much legitimacy in this respect as the LMCA:
	"The Government has been truly determined to get rid of an effective local voice for patients in the form of Community Health Councils . . . This amendment"—
	new clause 5—
	"offers a compromise and an opportunity for patients to have an independent and powerful say in what's happening to their health services locally."

Hazel Blears: Organisations take specific views and I shall outline why our proposals encompass all the functions in new clause 5 and will enable us to go even further. I have described them to my hon. Friend the Member for Wakefield as patients councils plus, and I genuinely believe that those on the way in which the commission would operate are exactly that.
	We have heard the arguments about reform on various occasions. Over the past five years—the period highlighted by the hon. Member for West Chelmsford—the NHS has changed dramatically and it is about to change even more fundamentally still. Therefore, there is a need to put in place a new system of patient and public involvement that properly reflects all the different NHS levels and functions to ensure that, where there needs to be public involvement, it is sited in the most appropriate place in the service so that it can act as a key lever for driving up standards and change. No longer should patients be outside the system, able to react only after the event.
	The hon. Member for Southend, West (Mr. Amess) has gone to his CHC to look after the interests of his constituent, who appears to be in a dire situation, but the CHC has to act after the event and from the outside. The new structures will put the PALS system inside that trust, so it will be on the spot to provide assistance to that constituent where it matters and when he or she needs it. The system will be a powerful force for ensuring that the trust, its consultants and the service that that constituent receives improve. Therefore, I genuinely believe that what we are introducing is much more appropriate for the changed NHS. We are putting patients and the public right at the heart of the system, which is where they need to be and where they can make the most difference.
	I want to deal in detail with the concept of patients councils in new clause 5. As my hon. Friend the Member for Bedford (Mr. Hall) said, it is important that I set out how the commission would work so that people can visualise the way in which the system may be drawn together. All the concerns about fragmentation can be addressed. Many Members have mentioned the need to ensure that the system is integrated and that there is an overview of the whole health community. That is very important.
	The concept of patients councils, which was introduced by previous legislation, has helped to inform the arrangements before us. Over the past year, we have developed our proposals in the light of those ideas and many others. This has not been a static process in which the Government have taken a fixed view. We have taken on board the views of many stakeholders in the system and the proposals have been much improved over the past year or so.
	The system will take on board all the functions set out in new clause 5, but it will also allow for a more dynamic and much more influential arrangement that is fit for the purpose of empowering all the people whom we want to involve in the NHS. First, we all agree that there must be a mechanism to pull together the informed overview of the patient experience across a specified area. That overview is fundamental. We must ensure that we collect all the data from PALS, the patients forums, the trends and the themes that emerge from independent complaints and advocacy services so that we have in one place all the information we need to know what the NHS is like in a certain community or neighbourhood and what is causing concern regularly, not just as a one-off. Currently, there is no one place in which all that intelligence can be held, but we shall be able to ensure that there is such a place in future.
	The commission will go out locally and engage hard-to-reach groups and people from marginalised communities. It will get not only the views of long-term and acute patients, but, perhaps, those of the homeless, people in the travelling community and people from black and ethnic minority groups—the voice out there that has never shaped the service before. The commission may use that data, that intelligence, those views and those concerns to ensure that reports are prepared not narrowly—

Mr. Deputy Speaker: Order. If the Minister does not address the Chair, it is difficult to hear her.

Hazel Blears: I apologise, Mr. Deputy Speaker.
	The commission will draw in all that experience across the local area. We all agree that patients do not fit conveniently or snugly into NHS or local government boundaries and that patients' experience often transcends various trusts—they go from one to another. It is important that we are able to draw that experience together. We must ensure that patients forums and ICAS providers are sufficiently supported so that they can develop.
	Patients forums in particular are new organisations and they will need to be properly staffed and facilitated to ensure that they can grow. Those organisations must work together to share their outcomes, plan joint work and identify trends and themes. Above all, the whole patient and public involvement system must be geared to hearing the voices of people, not a few representatives who purport to speak for the community. The community must find a way to express itself.
	The public will want to know how they can gain access to every part of the public and patient involvement service, where they can get in touch with PALS, how to get in touch with patients forums, what the overview and scrutiny committees will do, what the Commission for Patient and Public Involvement can do for them and where, at every single point, they can get their needs, concerns and grievances addressed. It is absolutely crucial that all those organisations be led by the public and by patients—lay members determining their priorities in the community.
	All those provisions are dealt with in the Bill, so new clause 5 is unnecessary, not because the issues are unimportant, but because they are catered for and because such a patients council might prove inhibiting to other important features.
	The Commission for Patient and Public Involvement in Health is the fundamental change to our proposals following the introduction of the Health and Social Care Act 2001. It will have core national functions and a range of local functions that have been universally recognised as being pivotal to the system's effective operation. The Bill says that the commission must operate at PCT level in local communities.
	Patients forums will have their ear to the ground in respect of the trusts and PCTs to which they relate. They will have a real insight into what patients really think about trust services. We acknowledge that they will be trust focused, so we must ensure that that knowledge and insight is brought together. What does it mean for patients overall? We intend to require patients forums to come together regularly to share their findings and to talk about emerging trends.
	As is argued for the patients council, information sharing is critical to ensuring that the patient's journey is truly understood and captured. We shall use the regulation-making powers in clause 15(4) to require patients forums to work together. That will enable best practice to emerge and inform the commission about those areas in which there are stresses and strains and where further work is needed. A strength of CHCs was that they could see such trends emerging. We shall ensure that that strength is not lost in the new system.
	We envisage the commission and patients forums forging partnerships across different boundaries. We do not want to tie those boundaries down to specific and restrictive areas, because they will work in many different ways. Many issues span different PCTs and the commission will need to work across those areas and with lay members in partnerships and to have the flexibility to do so.
	We think that the concept of a patients council, as expressed in new clause 5, would inevitably result in a limiting of the remit of the public and patient involvement system. It would also require a service organisation to support that organisation. I am keen to maximise the use of our resources in carrying out the consultation work that local people want to happen, instead of in servicing committees, taking minutes and the other aspects of a bureaucratic organisation. There would need to be 150 patients councils established, which would mean another 150 bodies in what hon. Members have already called a complex and complicated system. I do not want us to be tied to servicing such organisations, although the functions of the patients councils are crucial to making the system work.
	We have to ensure that the commission will respond to what patients forums tell it are the important issues in their community. We have the flexibility in the Bill to make secondary legislation that will set out the relationship between the commission and patients forums, to ensure that when forums highlight an issue the commission takes it on board. We can ensure that patients forum representatives—the lay members—set the work programme for the commission and ensure that community priorities are at the top of the agenda. We shall use regulation-making powers to require the commission to have specific regard to the recommendations of joint patients forums when planning programmes of work.
	By using the two regulation-making powers already in the Bill, we will be able to set up all the functions of the patients councils, as set out in new clause 5, and we can do much more. We will not be rigid or tied to a specific structure. The commission will go out into communities and hear those different voices and draw in those socially excluded groups and marginalised communities. We will be able to move on. It is a matter of having the courage to consider new ways of working. We are all tempted to stick with what we know because it is comfortable and we have seen it in practice, but we must now push forward the boundaries and consider new ways of working to empower the public, too.

Evan Harris: Nothing in new clause 5 prevents the Secretary of State from making regulations to fine-tune the functions of patients councils, but the Minister described the provision of staff who would enable patients to make their views known to the relevant organisations as creating a bureaucracy. However, when staff are provided to support other organisations, that is called providing appropriate support for effective mechanisms. Simply labelling something a bureaucracy when the Government do not like it is not worthy of the issues involved.

Hazel Blears: I assure the hon. Gentleman that there will be staff. The staff of the commission will support the patients forums. The staff will also go out into the communities to find the volunteers mentioned by the hon. Member for Westbury (Dr. Murrison) and give them support, education, training and guidance—which they have never had before—before they are placed on patients forums and other bodies. That will ensure that patients and the public are empowered to challenge professionals. The representatives will be really fit for the purpose of serving on those bodies and will be able to feel that they can make a significant difference and a real contribution.
	One of the aims of patients councils will be to make real links with local government. Some of the biggest determinants of good health are the issues that local government is responsible for, such as education, housing, transport and the environment. The commission will not be confined to an NHS model but will be able to make crucial links with local government, which have been championed by my hon. Friend the Member for Wakefield on many occasions. I am a little disappointed that my hon. Friend is not able to trust the Government's undertaking to put these measures into law through the use of the regulation-making powers. I have put our intention to ensure that those functions are carried out on the record and I am disappointed that my hon. Friend will not accept that.
	Amendment No. 73, supported by the hon. Member for Hexham (Mr. Atkinson), deals with the rights of patients forums to inspect various properties. The matter was raised in Committee and I said that I would consider it. It is not our intention to hand to patients forums a set of draconian powers. We have said that patients forums should be able to inspect everywhere a patient goes, but that does not mean a right of access to private living accommodation. There will be appropriate limitations and restrictions in the regulations that we intend to enact. It will be necessary to spell out the circumstances in which patients forums can inspect various properties, and we will have to be conscious of the right to privacy under the human rights legislation. I therefore reject the amendment, but I hope that the hon. Gentleman will accept my reassurance.
	Amendments Nos. 38 and 70 relate to the accounts and funding arrangements for patients forums. Independence for patients forums was a key issue in Committee and it is our intention to reinforce their independence through the legislation. There is a saying that he who pays the piper calls the tune, and concern was expressed in Committee that if trusts were to be responsible for the finances of patients forums, those bodies would not feel able to be critical or independent. Government amendment No. 38 will ensure that it is the Commission for Patient and Public Involvement in Health that will provide the funding and accounts for patients forums as arm's-length independent organisations. That will ensure that patients forums are independent of trusts in every way, including in their financing. I would hope that that will be sufficient for the hon. Member for Oxford, West and Abingdon (Dr. Harris) to withdraw his amendment.
	I turn to the relationship of patients forums with the rest of the proposed system. Patients forums will be powerful and influential bodies, but we recognise that there will be times when the forums might feel that a significant issue from the patient's perspective has not been properly taken account of by the trusts that they monitor. In such circumstances, the forums might want to alert the overview and scrutiny committees, which will have the legal powers to scrutinise the NHS on that issue. Local OSCs will provide the democratic element, through democratically elected members, and we think it right that forums should refer issues of concern that have not been satisfactorily addressed to the OSC. The amendment has been widely welcomed by ACHCEW and patients' organisations, and I hope that hon. Members will also welcome it.
	The democratic rights of local government must be a matter for its determination. We do not want to add to the Bill a requirement for OSCs to respond to referrals from the patients forum, because it is properly a matter for local government to decide what to do with those referrals in the course of the programme of scrutiny. However, it would be good practice to respond and we shall put in guidance our view on how OSCs should perform their functions. We would like to see a close relationship between OSCs and the patients forums. The OSCs should indicate, when they get a referral, what they intend to do—whether they will note the matter or look into it further. Government amendment No. 33 will join up the system between patients forums and OSCs, and I hope that it will be welcomed. Consequential amendments provide the necessary definitions and, on that basis, I would ask the hon. Member for Oxford, West and Abingdon to reconsider his amendment.
	In Committee, the important matter of the right of overview and scrutiny committees to refer contested reconfigurations to the Secretary of State was raised. At the moment, the way in which community health councils deal with the matter is, as I said in Committee, tortuous, in that they rely on referrals to regulations. These are important matters, and I want the new powers for overview and scrutiny committees to refer contested reconfigurations to the Secretary of State to be no less rigorous than those that community health councils enjoyed.
	I also want to clarify the situation about referrals on process and on merit. In relation to new clause 8, I would like to be able to consider further the details that are proposed. The drafting proposed by the new clause may not be sufficient to achieve the objective, and I would want to consider the proposals further.
	Finally, new clause 7 seeks to amend section 11 of the Health and Social Care Act, which provides a duty on the NHS to make arrangements to involve and consult the public on decisions that it takes about the provision and delivery of services. It is not necessary to include the Secretary of State in the list of bodies to whom section 11 of the Act applies. The Secretary of State himself delegates all functions in relation to health services—to health authorities, to NHS trusts or to PCTs.
	A full list of potential providers of health services is already included in the Health and Social Care Act. Paragraph 34(a) of schedule 8 to the Bill extends the provision to strategic health authorities. On that basis, I would resist the new clause. There is sufficient definition of the bodies that are required to consult under section 11 to fulfil all the scenarios that have been put before us. The hon. Member for Oxford, West and Abingdon is going down the road of hypothetical situations and the Bill will be sufficiently robust to meet his concerns.

Evan Harris: What about my point about NSCAG?

Hazel Blears: I have made the point that all the health service's functions are delegated by the Secretary of State. The way in which the consultation is carried out—whether by a lead strategic health authority or by a national organisation—is a delegation by the Secretary of State of a function of the health service. I genuinely believe that the Bill is comprehensive enough to cover the scenarios set out by the hon. Member for Oxford, West and Abingdon.
	I hope that, during my speech, I have answered most of the issues that hon. Members have raised. Through the new system, we are genuinely trying to achieve a much more robust, independent and effective system of patient and public involvement. Hon. Members must look forward and have the courage to embrace new ways of working. They must not simply look for the traditional systems that they know and love but which do not provide an effective, independent and vigorous system for patients in our health service. This system will deliver that for the good of the people whom we represent.

Simon Burns: I listened carefully to the Under-Secretary, and I think that she and the Government are trying to sell us a pup. She gave no credible reason why community health councils should be abolished. She gave no credible explanation of why they could not be reformed and kept in an improved state. For that reason, I ask my right hon. and hon. Friends to support new clause 2.

Question put, That the clause be read a Second time:—
	The House divided: Ayes 194, Noes 323.

Question accordingly negatived.

New Clause 3
	 — 
	The Health Inspectorate

'(1) There shall be a body corporate known as the Health Inspectorate, which will take effect from 1st April 2004.
	(2) The Health Inspectorate shall assume at that date the functions undertaken prior to that date by—
	(i) The National Institute for Clinical Excellence,
	(ii) The Commission for Health Improvement,
	(iii) The National Care Standards Commission, and
	(iv) The Council for the Regulation of Health Care Professionals.
	(3) The Secretary of State may by order make such amendments of the legislation relating to the health service in England and Wales as in his opinion facilitate, or are otherwise desirable in connection with subsections (1) and (2) above.'.—[Mr. Heald.]
	Brought up, and read the First time.

Oliver Heald: I beg to move, That the clause be read a Second time.

Mr. Deputy Speaker: With this it will be convenient to discuss the following: Amendment (a) to the proposed clause, in line 5, leave out—
	'(i) The National Institute for Clinical Excellence.'.
	Amendment (b) to the proposed clause, in line 8, leave out—
	'(iv) The Council for the Regulation of Health Care Professionals.'.
	New clause 4—Public health functions of the Commission for Health Improvement—
	'The Commission for Health Improvement shall have such further functions as may be prescribed relating to the management, coordination, provision or quality of public health services for which prescribed NHS bodies, service providers, local authorities or other bodies have responsibility.'.
	New clause 10—The Commission for Health Improvement: amendments to section 20 of the Health Act 1999—
	'(1) Section 20 of the Health Act 1999 is amended as follows:—
	(2) After paragraph (1) (e) there is inserted—
	"(f) the function of conducting reviews of and making reports on the guidance on priorities for the NHS set out by the Secretary of State, regional directors of the health service, and Strategic Health Authorities"
	(3) After subsection (1) there is inserted—
	"(1A) in carrying out the functions set out in subsections 20(1)(a) to (e) the Commission shall, where appropriate, review, investigate and report on the guidance on priorities for the NHS set out by the Secretary of State, regional directors of the health service, and Strategic Health Authorities."
	(4) Subsections (3) and (4) are repealed'.
	Amendment No. 89, in clause 12, page 17, line 15 after "others", insert—
	'(including but not limited to the National Institute for Clinical Excellence, the relevant royal colleges, regional directors of the Health Service, the NHS Executive and the Secretary of State)'.
	Amendment No. 88, in page 17, line 29 at end insert—
	'(1C) The criteria referred to in subsection (1A)(b) shall be agreed between the Commission, the Secretary of State and the relevant royal colleges, which shall take due account of the adequacy of resources available to meet the performance indicators.'.
	Government amendments Nos. 29 to 32, and 57 and 58.

Oliver Heald: In a world of reform by soundbite, where the answer to every issue is to set up a new commission, a new institute, a new agency or a new committee, surely there comes a time—[Interruption.]

Mr. Deputy Speaker: Order. Hon. Members who are interested in holding private conversations—[Interruption.] Order. That includes the hon. Member for Worsley (Mr. Lewis). Hon. Members who are not interested in listening to the debate would serve their colleagues better by leaving the Chamber.

Oliver Heald: Surely there comes a time to rationalise, and new clauses 3 and 4 would do just that. New clause 3 would combine the functions of the National Institute for Clinical Excellence, the Commission for Health Improvement, the National Care Standards Commission and the Council for the Regulation of Health Care Professionals in one body known as the health inspectorate.
	The Government have a piecemeal approach to reform: an issue arises, a committee is set up. That has led to a plethora of commissions, institutes and the like. It has also led to particular issues to do with the National Care Standards Commission and the CHI. The NCSC will monitor and inspect private sector providers. The CHI will inspect the same providers if NHS patients are at their premises. Surely only one body should do that work.
	We know that Government policy is changing fast. Only last year the Secretary of State was saying that the national health service was "thankfully" a monopoly provider. The right hon. Gentleman said that
	"by and large, we thankfully have one monopoly provider and that is the NHS. As long as a Labour Government are in power, that will remain the position."—[Official Report, 26 June 2001; Vol. 370, c. 500.]
	When the Bill was being prepared, that was indeed the right hon. Gentleman's view; yet by 7 December 2001—six months later—he was saying:
	"Where we need to get to is a position where the NHS is no longer a monopoly provider of care but it does become a monopoly funder of care."
	In other words, in six months, the Secretary of State went from a monopolist to a non-monopolist.
	Having given us the NHS plan in 2000 and the Bill in 2001, the right hon. Gentleman has now come up with another big idea to rescue the day. The reason is that, despite his promises and despite his words, he was wrong. There has been no delivery: all talk, no delivery.
	Today we have heard about foundation hospitals. As the changes are made, the case for an all-embracing health inspectorate grows. There would be no demarcation disputes between private sector monitoring and public sector monitoring. There would be less red tape and better co-ordination. There would be fewer burdens on busy clinicians, nurses and other staff. Indeed, if some of the comments are to be believed, the Government will embrace a national health service provided by third parties and will simply act as a regulator. In that case, why do we need this plethora of commissions, inspectorates and the like? Surely it makes sense to rationalise the situation.
	Under new clause 4, we would extend the role of the CHI to cover the monitoring, inspection, reporting, co-ordination, management and quality of public health. On 10 January, the chief medical officer announced a new committee—the national infection control and health protection agency—which will assess the threat of new and emerging infections and diseases and implement vaccinations. That is necessary simply because of the Government's lamentable failure in public health.
	In a report published in February 2000, the National Audit Office exposed huge discrepancies in performance between hospitals. It found that infections caught while in hospital were killing about 5,000 people a year and infecting about 100,000. The very old, the very young, those undergoing invasive standard procedures and those with suppressed immune systems were particularly susceptible. Hospital staff were not practising basic hygiene. The NAO found that infection rates could be reduced by 15 per cent. by better application of existing knowledge and realistic infection control practices.
	The NAO also found that there was insufficient funding, that there was no up-to-date information and that hospital infections were costing the health service £1 billion a year. It said that the NHS could save hundreds of millions of pounds if it tackled infection seriously, and that the high number of patients occupying beds and contributing to the problem could be improved.
	Against that background of the Government's failure to take public health and infection seriously, exactly what happens when Labour is in power can be shown by referring to certain diseases. The number of tuberculosis cases has risen enormously in recent years. In September 1999, the Department of Health asked the health authorities to suspend routine immunisation in schools for 10 to 14-year-olds because of a shortage of vaccine, yet that programme has still not been fully reinstated.
	The number of BCG vaccinations fell from 518,000 in 1997 to 137,000 in 2001—a decrease of almost 400,000—yet the number of TB cases reached a 15-year high. According to the British Thoracic Society, the number of adults and children with the respiratory disease TB was at record levels. The figure rose by a fifth between 1987 and 1988, and London has become the capital for TB.
	The rise in sexually transmitted diseases has been remarkable, too. Between 1999 and 2000, the incidence of syphilis increased by 51 per cent.; gonorrhoea increased by 25 per cent.; and chlamydia by 12 per cent. We have seen a similar picture with other diseases. So there is an epidemic of TB and sexually transmitted diseases are increasing.

Evan Harris: I am interested in the hon. Gentleman's topic; it used to be my field, but I am little confused—perhaps I am missing some amendments—about its relevance to new clause 3, about which important issues remain to be discussed. He refers to important issues, but they are not necessarily connected with new clause 3.

Oliver Heald: Perhaps I have been so speedy in my remarks that the hon. Gentleman has not noticed that I have moved on to new clause 4, under which we would require the CHI to take an interest in public health services. The reason why that is important is the Government's neglect of very important issues, such as those diseases, and the hon. Gentleman might make common cause with us about that. Certainly, when the Select Committee report on public health was debated recently in Westminster Hall, he and I agreed that the Government have an appalling public health record.
	Although the chief medical officer has belatedly set up yet another committee, the hon. Gentleman may agree—certainly his amendments to new clause 3 suggest it—that it would be better to have one effective body than to have committee upon committee upon committee. On 10 January, the chief medical officer reported that he was setting up the national infection control and health protection agency, but the new clause suggests that the Commission for Health Improvement could deal with such issues as well.
	One hopes that the Commission for Health Improvement will give advice to all the health bodies in the country. If it has the role of providing advice and support, it is surely odd to set up yet another new agency to give advice on public health when we already have a body that meets and liaises with all the other bodies and authorities to deal with the issues. We therefore suggest the rational approach of dealing with the matter through one body.
	The Government have recently, belatedly, produced a strategy on sexual health. However, there has been great criticism of it. The response from the George House Trust has been to say that the Government are following the "wrong strategy". It states:
	"Much is made by the Government of the need for the 'joined-up working' . . . but not so on HIV."
	It points out that to achieve
	"the long term aims of a reduction of HIV transmission and the best possible quality of life for people with HIV requires a cross-Government approach."
	It criticises the Government for providing something worse than that, adding:
	"The document almost doesn't deserve the name 'national strategy'."
	Building on their weakness on this issue, the Government have produced yet another document that is short on the sort of detail that those in the community who have to deal with such illnesses think is necessary.

John Hutton: I understand that the hon. Gentleman's new clauses and amendments deal essentially with the role and responsibilities of the Commission for Health Improvement for what he described as public health areas. He has now moved on to the sexual health strategy and sexual health services, but that is one issue for which the Commission for Health Improvement already has competence and jurisdiction.

Oliver Heald: The point that I am making is that we should join up the functions. If the Minister had attended the debate in Westminster Hall, he would know that public health is a well recognised field. Like the Select Committee on Health, we went through the history of the subject and back to 1850 and the earliest steps taken in public health. We reached the conclusion—and a consensus even with the Minister's colleague who attended the debate—that sexual health was part of public health. It obviously has a medical dimension too.
	On haemophilia, the fact that recombinant factor 8 is not available across the whole United Kingdom has been a failure of public health policy. So the public are right to be concerned that the Government do not know what they are doing for public health. The Select Committee on Health has done an important job of highlighting the vital nature of the issue, but I return to my central point. Why do we need yet another new committee? Why not give the Commission for Health Improvement the job of being a combined inspectorate that brings together the four bodies mentioned in new clause 3, while having additional responsibilities for public health?
	The British Medical Association has expressed concern that the new arrangements in the Bill may lead to some areas having no public health doctor advising either the PCT or the strategic health authority. Will the Minister address the issue and tell us whether he is satisfied with that? The national tracker survey mentioned in previous debates concluded that
	"most PCGs and PCTs feel they need more public health support".
	So why not give the job to the people who advise on all the other matters? Why not give it to a unified body or to the Commission for Health Improvement?
	Other new clauses and amendments are before the House, and I shall leave it to other Members to describe them. However, I hope that the Minister will, for once, move away from the Government's gimmicky, soundbite approach that we see so often. Every time there is a problem, they set up a committee. Why can we not rationalise and at least bring all the powers together in one body?
	On a non-partisan note, when financial controls and checks were disparate and a plethora of bodies dealt with financial regulation, the Chancellor of the Exchequer considered the problem and decided to bring those bodies together with a strong regulator, the Financial Services Authority, to cover all financial regulation. If that is good enough for financial regulation, why is it not good enough for health regulation? Let us bring the bodies together, give them some teeth and have real expertise. I ask the Minister to look on the new clause with the same affection as he showed for our proposals on consultation.

Evan Harris: Before addressing the new clause and amendments that the Liberal Democrats have tabled, I want to deal with new clause 3, which would amalgamate the functions of the Commission for Health Improvement, the National Care Standards Commission, the National Institute for Clinical Excellence and the Council for the Regulation of Health Care Professionals. I am half with the Conservatives on that. The hon. Gentleman knows that for a long time we have thought that there should be one quality regulator for both the private sector and the NHS. Such an inspectorate would have specialist departments to deal with, for example, the inspection of care homes, on which my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) is an expert. We believe that the nature of the inspectorate should be to consider issues of quality in both sectors, with powers to be discussed and arranged later in our proceedings.
	We also believe, however, that NICE and the Council for the Regulation of Health Care Professionals are separate bodies with separate functions. We have made it clear to the Government that we support their quality initiative, even if it means more acronyms. That is the price we have to pay for the previous lack of machinery to deal with quality assurance in the health service. So we accept that two of the bodies could be combined, which is the purpose of amendments (a) and (b) to new clause 3.

Oliver Heald: Does the hon. Gentleman agree that when the Government thought of having two bodies, they favoured a monopoly supply in the NHS, so there would have been little overlap? Now that they are coming forward with changed proposals, it is far more important that one body should deal with such matters; otherwise, more than one body will survey the same premises.

Evan Harris: The hon. Gentleman is too generous. I do not think that the Government provided a rational reason for the separation, especially with regard to the fact that NHS patients in private hospitals would be subject to Commission for Health Improvement inspection, which means two separate bodies going to similar sectors. It is true that the then Secretary of State took a separatist view of the private sector, but I do not think that that approach was ever rationalised. I do not believe that it can be.

John Hutton: The hon. Gentleman, like the Conservatives, overlooks the implications and consequences of section 9 of the Care Standards Act 2000, which prevents the duplication to which he refers. In the present situation, it offers a sensible way to deal with his reasonable concerns and criticisms.

Evan Harris: That section might deal with one form of duplication, but it does not address the duplication of structure. I am concerned about the duplication of two bodies that could more easily pool best practice and identify lessons to be learned from each other by being in one inspectorate. I am sure that if we revisited this issue, the Government would accept the establishment of one body, albeit with different specialisations.
	New clause 10 is important and touches on matters that we raised in Committee. The Government say that they want the CHI to be more independent. Together with amendments Nos. 88 and 89, the new clause would ensure that they deliver on that and that the body really is independent. Under the cloak of greater independence, the measures would have the commission doing the Government's bidding, because it will be put in charge of measuring hospitals against performance criteria laid down by the Government, but it will have no duty to ensure that those criteria are sensible.
	Amendment No. 89 seeks to ensure that those criteria would be discussed and agreed by the commission, the Government and the royal colleges. The commission, rather than simply measuring how well hospitals, trusts and PCTs jump through hoops and how high they jump, should have some input, with the royal colleges, in determining the nature of the hoops.
	In the past, there have been ridiculous performance criteria with political objectives. In fact "ridiculous" is a polite description. For example, trusts that put patients ahead of political targets by treating urgent cases quickly, even at the expense of creating a few more long waiters—I accept that in general waiting times are too long—get marked down in performance tables compared with those that deal with long waiters, and have no one waiting over 15 months, by delaying waiting times for urgent operations from one month to three months. Patients come out worse in the second case, but the trust scores higher on the crazy performance criteria.
	I accept that there must be some performance monitoring, but let us have sensible criteria. Politicians will do as they do, so it would be sensible to ensure that the commission is able to agree criteria with the Government and the royal colleges. The Government have made efforts to engage the royal colleges in such discussions, but it is clear, as the Minister said in Committee, that the criteria in the Bill will be set by the Government and they will be designed to meet Government targets.
	The Government should not be allowed to get away with imposing distortions on the health service unless they are satisfied that they can pass muster with the newly independent commission. New clause 10 would give the commission the power to conduct reviews and draw up reports on the guidance on NHS priorities set out by the Secretary of State and the people to whom he delegates those powers. If priorities and planning guidance emerged that would not inevitably lead to improved quality but merely dealt with subsidiary matters unrelated to patient outcomes, they could be subject to a report by the commission. The Secretary of State could, of course, choose to ignore that report, but at least the information would be out in the open, and the Minister would have subjected the priorities emanating from his Department to the same scrutiny as the conduct of the trusts that seek to meet those criteria will be subjected to.
	One amendment seeks to ensure that when setting the criteria some regard would be paid to resources and their effect on the ability of hospitals, trusts and PCTs to meet those criteria. There is nothing more invidious and depressing for trusts than to be named and shamed, as the Government indicate they will do and as they have done through the zero rating, when they fail to meet performance criteria, solely because they do not have the necessary staff or capacity. Delayed discharges, for example, are well beyond the control of even the best public sector or even—dare I say it?—private sector managers. That amendment should not be a threat to the Minister; indeed, he may argue, as I do, that it would be a benefit because it would ensure that trusts get a fair deal. Without performance monitoring that does not have a devastating effect on morale, we will not have the health service that we require.
	I hope, Mr. Deputy Speaker, that at the appropriate moment you will allow us to call a vote on new clause 10, if the Government oppose it.

John Hutton: I shall speak to the Government amendments before I turn to those in the names of Opposition Members. Amendments Nos. 29 to 32 are technical amendments that relate to the Commission for Health Improvement. Amendment No. 29 concerns the commission's investigatory role, and the remaining amendments deal with its role under the new system of local health boards to be established in Wales.
	Amendment No. 29 is designed to ensure that confidential information can be disclosed to the Commission for Health Improvement when it is carrying out investigations in relation to special health authorities or other bodies that may in future be prescribed in regulations under section 20(1)(e) of the Health Act 1999, not only when it carries out investigations in relation to health authorities, PCTs and NHS trusts. Whenever we discuss confidential information and its disclosure, it is important that we address the essential safeguards needed to ensure that there are no abuses. Those safeguards have already been built into the existing legislation.
	The Commission for Health Improvement may obtain personally identifiable confidential information only in the circumstances specified in 23(2)(d) of the 1999 Act. Broadly, those circumstances are where it is not practicable to disclose the information in an anonymous form; where there is a serious risk to the health or safety of patients; and where the risk and urgency involved mean that the information needs to be disclosed without consent. Those are stringent and necessary safeguards.
	Amendments Nos. 30, 31 and 32 are technical drafting mechanisms to address the fact that local health boards will be set up at a future date in Wales. Amendments Nos. 57 and 58 are also technical amendments, consequential on the creation of local health boards. The practical effect of amendment No. 57 would be to ensure that CHI's functions in relation to local health boards under section 20 of the 1999 Act operate once such boards are established and given responsibility for health care. The practical effect of amendment No. 58 would be to ensure that local health boards are subject to the appropriate provisions of existing legislation.
	The principal debate and arguments in relation to this group of amendments has concerned new clauses 3, 4 and 10. New clause 3 seeks to create a new health inspectorate by bringing together a number of current or proposed bodies. In tabling new clauses 3 and 4, the hon. Member for North-East Hertfordshire (Mr. Heald) has, properly and correctly, raised an important issue with which I have a great deal of sympathy. However, I have serious doubts about the drafting and wider effects of the new clauses, which means that I cannot accept them this evening. Clearly, as the hon. Gentleman said—and I agree—there is a strong case for effective co-ordination between various agencies in the field and for ensuring that the NHS is not subject to unnecessary or bureaucratic regulatory inspections. That is a key objective for the Government, which we need to keep under careful and continuous review.
	My overall concerns about the new clauses, especially new clause 3, are to do with the mixture of distinct functions and the disruption that that kind of change would inevitably cause at this moment in time, particularly when the National Care Standards Commission has not even begun to discharge its statutory functions and CHI has not taken on its new and expanded role under the Bill. While there is no doubt at all that the sort of collaboration and co-ordination that the hon. Gentleman and I want must continue and be strengthened, the proposed health inspectorate would create a new body with what might be described as an indigestible and confusing mixture of NHS and wider regulation and inspection roles. As I said in an intervention on the hon. Member for Oxford, West and Abingdon (Dr. Harris), we should not lose sight, in our rush to reform, of other ways in which we can facilitate the type of operation that he and I want to see, especially the use of section 9 of the Care Standards Act 2000.
	We have already made provision for greater co-ordination between CHI and the Audit Commission in the Bill. Additionally, we have provided powers for the sharing of functions between the National Care Standards Commission and CHI, which has entered into important memorandums of understanding with a range of organisations, such as the royal colleges. We were able to send copies of those memorandums of understanding to members of the Standing Committee; I hope that they found that useful. In the present circumstances, that is the right way to proceed.
	I wish to make it clear to the House that we are considering, as part of our response to Professor Kennedy's report on the Bristol royal infirmary inquiry, what further steps might be taken to improve the co-ordination of the activities of those various bodies. As the hon. Member for North-East Hertfordshire, and, I hope, the House, knows, the Government's response to the report will be published in the near future. While I fully understand his arguments and strongly sympathise with them, I am not in a position to support his particular attempt to resolve those problems. As I said, the difficulties can be addressed in the present circumstances in other ways—less bureaucratic ways than the drastic changes and upheavals proposed. That is particularly true in relation to the National Care Standards Commission, which has not yet started its work.
	Amendments (a) and (b) tabled by the Liberal Democrats to new clause 3 would mean that the new health inspectorate would perform the functions of the Commission for Health Improvement and the National Care Standards Commission, but not those of the National Institute for Clinical Excellence or the new Council for the Regulation of Health Care Professionals. As I have already indicated, the proposal to establish a single health inspectorate as set out in new clause 3 may have some attractions, but it confuses the very different roles of the bodies concerned and ignores the actual and potential collaboration between them. By reducing the number of bodies involved, the amendments inevitably mitigate the confusion, but do not remove it entirely.
	I have tried to explain to the hon. Members for North-East Hertfordshire and for Oxford, West and Abingdon that we are examining the issues closely, but there are genuine difficulties with the new clause. The hon. Member for North-East Hertfordshire may or may not be prepared to accept that, but I assure him and the House that the Government are studying these matters carefully.
	New clause 4 would allow CHI to be given new functions in relation to what are described in the new clause as "public health" services. That is not a term defined in the Health Act 1999, which set up the Commission for Health Improvement. The hon. Member for North-East Hertfordshire was right to draw attention to the chief medical officer's report last week, which announced plans for a new national infection control and health protection agency, which is designed to streamline the services involved in the prevention and control of infectious diseases.
	The agency would subsume the functions of a number of the bodies of expertise which currently provide health protection services, including the Public Health Laboratory Service, the National Radiological Protection Board, the Centre for Applied Microbiology and Research—CAMAR—and the National Focus for Chemical Incidents.
	The establishment of such a new agency would clearly raise important questions about its relationship to the Commission for Health Improvement, to which we are not yet in a position to give a final answer, but which we will consider carefully. I accept that new clause 4 raises an important issue, which requires serious consideration, alongside the issues raised by the hon. Member for North-East Hertfordshire in relation to new clause 3.
	There are undoubted arguments in favour of giving recognition to the importance of public health services, as proposed in new clause 4. However, complex issues are involved in clarifying the range of public health services that might appropriately be brought within CHl's remit, the relationships with both the bodies responsible for those services and those responsible for their inspection or regulation now and in future, and the legislative consequences arising.
	I therefore propose that the new clause should not be accepted tonight, but I am happy to give an assurance to its proposers and to other right hon. and hon. Members that we are giving serious consideration to ways in which the issues that it raises might best be taken forward. I intend to keep right hon. and hon. Members fully informed of progress on the matter.
	The hon. Member for North-East Hertfordshire will not be surprised that I take issue with his general description of the Government's record in relation to public health. That traduces the policies that the Government are taking forward and fundamentally misrepresents them. The Government have a good and strong record in relation to public health issues, which we intend to pursue into the future.
	The hon. Member for North-East Hertfordshire raised a version of new clause 10 in Committee—

Oliver Heald: Does the Minister agree that there is a TB epidemic, vaccinations are down, and the sexual health of the nation is worse than it has been for a good deal of time? There are numerous public health issues—the re-use of surgical equipment is another, and all the diseases in hospitals. The Government's record does not look good. How would he defend it?

John Hutton: The hon. Gentleman gives a highly selective account. He did not mention, for example, the enormous success of the introduction of the meningitis vaccine into the NHS. He did not refer to the flu vaccination policy that we have successfully introduced, and which has made a significant impact on dealing with winter pressures across the NHS. He did not mention the introduction of new public health strategies and policies for young people, including the policy to ensure that children at school have access to fresh fruit.
	The hon. Gentleman can pick and choose and describe that record as a failure, but that is not an impressive argument. It overlooks the positive achievements. Of course, there is always more to do in the public health arena, but to say that the Government are doing nothing and that the public health of the nation has deteriorated is a travesty of the facts.
	In Committee, we had a revealing discussion with the hon. Member for Oxford, West and Abingdon about new clause 10, which would give the Commission for Health Improvement the additional function of reviewing guidance on NHS priorities issued by my right hon. Friend the Secretary of State, directors of health and social care regions and strategic health authorities. It would ensure that the commission reviews, investigates and reports on that guidance in carrying out its other functions. There is genuine disagreement between us about the proper and effective role of the commission and of Ministers and the House in holding the specified people to account. This is an important point to thrash out. He might say that I am presenting a travesty of his argument, but I must put it to the House that the new clause is about transferring responsibility for scrutinising the work of Ministers to the Commission for Health Improvement. That is the wrong thing to do.

Evan Harris: That is a travesty.

John Hutton: None the less, it is what the hon. Gentleman is trying to do and it is a mistake. It is perfectly legitimate and reasonable for Ministers, including my right hon. Friend the Secretary of State, to set priorities for the national health service. The hon. Gentleman's election manifesto was full of priorities for the national health service. It dealt with the extra staff that he wanted to recruit and the extra procedures and so on that the Liberal Democrats wanted to introduce in the national health service. It is complete nonsense to suggest that it is inappropriate for Ministers to set priorities for the public services, including national health services, and to be accountable to the House. They should be accountable not to a ministerial or public body set up by the House, but to the House itself. That is the right constitutional balance.

Evan Harris: I intervene merely to make the same point as I made in Standing Committee. No one is suggesting that these priorities should not be set by Ministers. One can argue about their volume and the frequency with which they are sent out, but the question is whether they will be open to scrutiny in terms of their impact on the quality of patient care. Use of funds is a separate issue.

John Hutton: Again, the hon. Gentleman misunderstands the current arrangements for ensuring the scrutiny that he and others, including me, want. It is not correct to say that the only way of ensuring the scrutiny that he and others want is to give the Commission for Health Improvement the proposed new function. A range of tools and mechanisms is available to aid the process of scrutinising Government policy. We should bear in mind the National Audit Office, the Audit Commission and the role of this place and the Select Committee on Health, which is so ably led by my hon. Friend the Member for Wakefield (Mr. Hinchliffe). A range of effective measures is already in place to ensure that the decisions taken by Ministers are subject to effective scrutiny. It is important that they are subject to such scrutiny. My argument with him is about his choice of the Commission for Health Improvement as the body that should provide additional scrutiny in respect of such decision making. I do not believe that that is the right way forward.
	As the hon. Gentleman knows, the Bill strengthens the powers of the Commission for Health Improvement to do a better job throughout the national health service and to report to the House on what it has found out about the state of the health service. If the Liberal Democrats are looking for more effective ways of scrutinising Ministers and more ammunition in that regard, he should be aware that we are providing him with exactly that sort of ammunition. It is up to them to use it, but it is incorrect to suggest either that the current arrangements are defective and therefore justify new clause 10 or that Ministers are fighting shy of giving the Commission for Health Improvement a range of effective powers to deal with the issues that he and others have raised.
	I have tried to set out my arguments clearly. I hope that the House will support the Government amendments and not seek to press the new clause.

Oliver Heald: The Minister's approach to new clauses 3 and 4 was constructive. We do not agree about the Government's record on public health, which we think is lamentable. None the less, he considered the new clauses and explained the complexity of the issues and made some points that I would like to consider further. I am not promising that the issues will not be raised again in the other place, but I shall not press the new clause. I beg to ask leave to withdraw the motion.
	Motion and clause, by leave, withdrawn.

New Clause 5
	 — 
	Establishment of Patients' Councils

'(1) The Secretary of State shall, subject to subsection (2) below, establish a body to be known as a Patients' Council ("Councils") in England in each area for which an overview and scrutiny committee has been established under section 7 of the Health and Social Care Act 2001 (c.15); each council shall be appointed from among members of relevant Primary Care Trust Patients' Forums and NHS Trust Patients' Forums operating in that area and representatives from relevant community interest groups.
	(2) Where it appears to the Secretary of State that there is a need to establish a Council for an area other than that represented by a local authority with overview and scrutiny functions, he shall, after local consultation, establish a Council for such other area as appears to him will meet the needs of the local community.
	(3) The functions of a Council are to represent the interests in the health service of the public in its district and in particular to—
	(a) facilitate the co-ordination of the activities of member Patients' Forums including by the provision of staff and services to Patients' Forums,
	(b) provide or make arrangements for the provision of services under section 19A of the NHS Act 1977 (independent advocacy services) at the direction of the Commission for Patient and Public Involvement in Health,
	(c) represent to persons and bodies which exercise functions in its area (including in particular the overview and scrutiny committees and the joint overview and scrutiny committees mentioned in sections 7, 8 and 10 of the Health and Social Care Act 2001) the views of members of the public in its area about matters affecting their health,
	(d) advise the bodies mentioned in subsection (4) on involvement of the public in its area in consultations or processes leading (or potentially leading) to decisions by those bodies or the formulation of policies by them, which would or might affect (whether directly or not) the health of those members of the public, monitor the effectiveness of this involvement and co-operate with the Commission for Patient and Public Involvement in Health in carrying out this function.
	(4) The bodies referred to in subsection (3)(d) are—
	(a) health service bodies,
	(b) other public bodies, and
	(c) others providing services to the public or a section of the public.
	(5) The Secretary of State shall, following consultation with the Association of Community Health Councils for England and Wales, Community Health Councils, patients' and carers' organisations and the wider community, by regulation make provision in relation to Councils as to—
	(a) the Patients' Forums and other community interest groups from which members of the Council are to be appointed,
	(b) any qualification or disqualification from membership,
	(c) terms of appointment,
	(d) the proceedings of a Council,
	(e) the discharge of any functions of a Council by a committee of the Council or by a joint committee appointed with another Council,
	(f) the circumstances in which Councils will co-operate with each other in the exercise of their functions and exercise functions jointly with one or more other Councils,
	(g) funding of Councils and the provision of staff, premises and other facilities,
	(h) the preparation and publication by a Council of annual accounts,
	(i) the provision of information (including descriptions of information which are or are not to be provided) to a Council by an NHS Trust, a Primary Care Trust, a Strategic Health Authority, the Commission for Patient and Public Involvement in Health, the relevant local authorities or a person providing independent advocacy services (within the meaning given by section 19A of the NHS Act 1977),
	(j) the provision of information by a Council to another person,
	(k) the preparation and publication of reports by Councils,
	(l) the furnishing and publication by NHS trusts, Primary Care Trusts, Strategic Health Authorities and Overview and Scrutiny Committees of comments on reports or recommendations of Councils, and
	(m) the referral of matters of a prescribed description to any overview and scrutiny committee, the relevant Strategic Health Authority, the Commission for Patient and Public Involvement in Health or the Secretary of State.
	(6) The regulations shall include provision applying or corresponding to any provision of Part 5A of the Local Government Act 1970 (c.70) (access to meetings and documents).
	(7) In section 21(10) of the Local Government Act 2000 (membership of overview and scrutiny committees) after the words "who are not members of the authority" there shall be inserted ("and shall include a person appointed by the relevant Patients' Council").
	(8) In paragraph 1 of Schedule 1 to the Health Authorities Act 1995 as amended by this Act after "(c) a prescribed number of officers of the Health Authority" there shall be inserted—
	"(d) persons appointed by the relevant Patients' Councils.".'.—[Mr. Hinchliffe.]
	Brought up, and read the First time.
	Motion made, and Question put, That the clause be read a Second time:—
	The House divided: Ayes 222, Noes 296.

Question accordingly negatived.

New Clause 10
	 — 
	The Commission for Health Improvement:amendment to section 20 of the Health Act 1999

'(1) Section 20 of the Health Act 1999 is amended as follows:—
	(2) After paragraph (1) (e) there is inserted—
	"(f) the function of conducting reviews of and making reports on the guidance on priorities for the NHS set out by the Secretary of State, regional directors of the health service, and Strategic Health Authorities"
	(3) After subsection (1) there is inserted—
	"(1A) in carrying out the functions set out in subsections 20(1)(a) to (e) the Commission shall, where appropriate, review, investigate and report on the guidance on priorities for the NHS set out by the Secretary of State, regional directors of the health service, and Strategic Health Authorities."
	(4) Subsections (3) and (4) are repealed'.—[Dr. Evan Harris.]
	Brought up, and read the First time.
	Motion made, and Question put, That the clause be read a Second time:—
	The House divided: Ayes 52, Noes 326.

Question accordingly negatived.

Clause 1
	 — 
	English Health Authorities: change of name

Amendment made: No. 23, in page 2, line 25, at end insert—
	'(4A) The Secretary of State may make regulations containing requirements as to consultation which must be complied with before he makes an order under this section which relates to a Strategic Health Authority, and if he does make such regulations he shall not make such an order unless such of those requirements (if any) as are applicable have been complied with.
	(4B) Consultation requirements contained in regulations under subsection (4A) are in addition to, and not in substitution for, any other consultation requirements which may apply.'.—[Mr. Hutton.]

Clause 2
	 — 
	Primary Care Trusts

Amendments made: No. 24, in page 2, line 41, leave out "is amended as follows" and insert—
	'(which provides for the establishment of Primary Care Trusts) is amended as provided in subsections (2) and (3)'.
	No. 25, in page 3, line 4, at end insert—
	'( ) Schedule 5A to the 1977 Act (which makes further provision about Primary Care Trusts) is amended as follows—
	(a) in paragraph 2(3)—
	(i) for "the Health Authority in whose area a Primary Care Trust is established to meet the costs" there is substituted "a Strategic Health Authority whose area includes any part of the area of a Primary Care Trust to meet costs", and
	(ii) in paragraph (b), after "meet" there is inserted "(or to contribute towards its meeting)",
	(b) in paragraph 2(4), for "the Health Authority in whose area a Primary Care Trust is established" there is substituted "a Strategic Health Authority whose area includes any part of the area of a Primary Care Trust",
	(c) in paragraph 16(1), for "the Health Authority within whose area the trust's area falls" there is substituted "each Strategic Health Authority whose area includes any part of the trust's area", and
	(d) in paragraph 16(3), for "the Health Authority within whose area the trust's area falls" there is substituted "any Strategic Health Authority whose area includes any part of the trust's area".'.—[Mr. Hutton.]

Clause 3
	 — 
	Directions: distribution of functions

Amendments made: No. 26, in page 3, line 17, after "Trust", insert "any part of".
	No. 74, in page 3, line 38, leave out from "under" to end of line 39 and insert—
	'preceding provisions), in subsection (1A)—
	(a) "or" is inserted after paragraph (a),
	(b) paragraph (b) is omitted, and
	(c) in paragraph (c), for "16D, 17 or 17A" there is substituted "16D or 17".'.—[Mr. Hutton.]

Clause 5
	 — 
	Local Representative Committees

Amendments made: No. 27, in page 5, line 24, leave out—
	'by the Strategic Health Authority whose area includes the area of the Primary Care Trust'.
	No. 28, in page 5, line 31, leave out—
	'by the Strategic Health Authority whose area includes the area of the Primary Care Trust'.—[Mr. Hutton.]

Clause 6
	 — 
	Local Health Boards

Win Griffiths: I beg to move amendment No. 22, in page 6, line 37, at end insert "but no more than fourteen.'.

Mr. Speaker: With this it will be convenient to discuss the following amendments: No. 21, in page 7, leave out lines 29 to 31 and insert—
	'(c) by both of the following: NHS trusts and Local Health Boards.'. No. 20, in clause 9, page 10, line 30, at end insert—
	'and
	(c) sums required, on application by Local Health Boards, to deal with major health emergencies.'. No. 10, in page 10, line 39, at end insert—
	'(2A) In determining the amount to be allotted to a Health Board, the National Assembly for Wales shall have regard to the health needs of the population served by that Board'. Government amendments Nos. 75, 84 and 85.

Win Griffiths: I want to devote some time in the Chamber to a brief discussion of the number of health boards that will be needed in Wales to ensure that an effective health service works in co-operation with local government. There is no need to press the amendment to a vote, as the Bill is flexible enough to allow the National Assembly for Wales to decide how many health boards are needed. The maximum number possible is 22, as that is the number of local government units in Wales. I have no problem with the principle that the units of government for the health service in Wales should be organised in the same way as the units of local government there. Where I differ with the National Assembly is that I believe that we should look at the degree of coterminosity between the health service and local government in Wales from the point of view of the health service, rather than of local government. Jane Hutt, the Minister for Health and Social Services in Wales, feels that it would be best to have 22 local health boards, which would work alongside the trusts in Wales. I believe that it would be better if the local health boards were to mirror the trusts in Wales, although I accept that in a few places it could be argued that the trusts are too large to have only one local health board. I am looking for flexibility, and I think that 14 local health boards would be enough to maintain the principle of coterminosity, and to deliver an effective health service in Wales. For example, in my Bridgend constituency, the present plans mean that Bridgend and Neath-Port Talbot will have separate local health boards, both of which will be within the boundaries of the Bro Morgannwg national health service trust. Under my proposal, there would be one local health board within the Bro Morgannwg NHS trust, and it would contain representatives of the two local government units. If that health board wanted to create separate sub-committees for Bridgend and for Neath-Port Talbot, it would be free to do so. I believe that my proposal would lead to the more efficient delivery of health services and to better co-ordination with local government. I have spoken to all the trusts in Wales that would be affected by the proposals, and two of them feel that they would have to negotiate with 22 local health boards for the delivery of the health services that they provide. I shall not go into the details, but more than two thirds of the trusts believe that their negotiating procedures with local health boards will be more complex than the same procedures with the existing health authorities. Therefore, my plea to the National Assembly is that it should reconsider whether 22 local health boards are needed, and that it should settle for a maximum of 14, or fewer.

Julie Morgan: Does not my hon. Friend agree that the advantage of exact coterminosity between health boards and local authorities is that preventive and primary care would be given the highest priority as a result of the authority's involvement with housing, the environment, transport and so on? Those issues are vital to health, and it would be bound to be to the advantage of the health of local people if they were the primary concern of a coterminous local authority.

Win Griffiths: I beg to disagree with my hon. Friend on this issue. In the Bro Morgannwg trust that covers my local authority area, there are two local authorities. One health board would have representatives of both local authorities. I believe that they would be able to negotiate better on that basis than if there were two separate local health boards. However, that is a matter of opinion. I believe that 14 would provide sufficient flexibility for one or two larger trusts to have more than one local health board. I hope that these issues will be considered seriously in Cardiff. As the person who had the honour of having responsibility for the health service in Wales immediately after the 1997 election, I created the local health boards—or groups, as they then were—because I wanted coterminosity between local government and the health service in Wales. In terms of their responsibilities, the local health boards will be mini health authorities. We will have much better local health boards if we have to staff 14 rather than 22. We do not have time to go into all the other arguments that I would like to make—I will put those privately to the Minister for Health and Social Services in Wales. However, I wanted to flag up this issue because it is important in delivering a more effective and efficient health service while still ensuring strong co-operation between the health service and local government in Wales.

Jon Owen Jones: I shall be very brief because there is hardly any time left. I agree with my hon. Friend the Member for Bridgend (Mr. Griffiths) that the number of health boards proposed is excessive. I believe that they are likely to be expensive and too bureaucratic. There is room in the Bill to reduce the number of boards so that we can maintain the coterminosity that my hon. Friend mentioned, while retaining a degree of efficiency and flexibility in the delivery of the health service in Wales.
	The majority of those working in the health service in Wales who were consulted and replied to the consultation also agreed that the number of bodies suggested in the new structure would be unwieldy. Unfortunately, the House has never been given proper access to an analysis of that consultation procedure, perhaps because the results would prove to be opposed to the proposals.
	There is sufficient flexibility in the Bill, as my hon. Friend has said. I ask the Welsh Assembly to retain coterminosity but to reduce the number of boards so that we can have an efficient system that delivers health care to people in Wales without tying them down to the over-bureaucratic and wasteful system that 22 boards would create.

Roger Williams: I should like to comment from a Welsh point of view. I pay tribute to the hon. Members for Bridgend (Mr. Griffiths) and for Cardiff, Central (Mr. Jones) in whose name the amendment stands. They were both responsible for the delivery of health services in the Welsh Office, as it then was, and were very helpful to people in my constituency when we were making representations on health issues.
	I was disappointed to see these amendments but rather glad to hear how they were interpreted by the hon. Gentlemen. I felt that the amendments went against the spirit of devolution in trying to tie the Assembly to a specific pattern for the health structure in Wales. That would have been unfortunate.
	The coterminosity element is especially important in the delivery of social services. One of the main impediments to that delivery in Wales—as it is in England and Wales—has been the delayed departure of patients from hospital to their homes or to nursing homes. The system will work much better if there is full coterminosity between local health boards and local authorities.
	I am pleased that the hon. Gentlemen are not going to press the amendment to a vote because the Assembly will certainly undertake further consultation and will take the results on board. The decisions reached by the Assembly will result in the most appropriate structure for Wales.

Oliver Heald: On a point of order, Mr. Speaker. We are not going to reach amendment No. 12 to clause 21. That clause was never discussed in Committee—nor were clauses 8 and 20—owing to lack of time. The timetable motion was hopelessly unrealistic. Would it be possible for you, Mr. Speaker, to consider whether there is some way in which you could use your offices to ensure that on a Bill of this sort we do not end up in the ludicrous position of being unable to debate three of its most important parts?

Mr. Speaker: By making a point of order the hon. Gentleman is taking time out of the debate. When I chair the proceedings, I take one amendment at a time. The fact that we shall not reach an amendment is not a matter for me to consider: I consider only what is before the House.

Hywel Williams: I am glad to hear the hon. Member for Bridgend (Mr. Griffiths) plead for coterminosity. That is an extremely important point. However, the House should bear in mind the points made in an earlier debate by the right hon. Member for Llanelli (Denzil Davies). He pointed out that under the current proposals there are likely to be as many as 52 bodies concerned with the delivery of health in Wales, as well as the Welsh Assembly Government—the WAG—and its Committees. That presents the obvious dangers both of complexity and of the lottery in health care.
	The proposal made by the hon. Member for Bridgend might, indeed, reduce the number of local health boards and that might be very useful in terms of critical mass—they might be more effective. It might also mean that we avoid some of the dangers that have become apparent since the reorganisation of local government brought in 22 small local authorities. Some of them cover small populations and are thus quite weak in respect of some of their powers and functions. However, the dangers of complexity and of a local lottery in health care would remain.
	I support my party's policy on this matter: to establish an all-Wales commissioning body. That is a coherent policy which would avoid complexity and the threat of a health lottery. It is also plain common sense in a nation of only 3 million people.

Paul Murphy: In the short time left for the debate, I commend Government amendments Nos. 74, 84 and 85. They are technical amendments that will ensure clarity as regards local health boards.
	My hon. Friends the Members for Bridgend (Mr. Griffiths) and for Cardiff, Central (Mr. Jones) were formerly Health Ministers at the Welsh Office. When Jane Hutt, the Minister for Health and Social Services in the National Assembly, reads our proceedings she will note their comments with great interest. I am sure that they and other Members who have spoken in this brief debate will agree that clause 6 refers to the establishment of local health boards by the National Assembly for Wales. It does not refer to a specific number of health boards. In other words, the principle of setting up local health boards is established by the House of Commons and by Parliament, but the Assembly, through the devolution settlement, agrees on the number.
	I know that my hon. Friends agree with that principle because it is the principle of devolution. The hon. Members for Brecon and Radnorshire (Mr. Williams) and for Caernarfon (Hywel Williams) also know that the secondary legislation that will implement the setting up of those local health boards has quite properly been devolved.
	After lots of consultation and debates in Committee, which my hon. Friend the Under–Secretary of State for Wales attended on behalf of the Government, and in the plenary season of the National Assembly for Wales, it was agreed that it would be sensible to ensure that the local health boards coincided with the local authorities that deliver other services, such as social services, and deal with other public health matters. That makes eminent sense, and in this very short debate we have seen the partnership between Parliament and the assembly work to deliver the best possible health service for the people of Wales. There has been a long consultation process on this issue, which is important to Assembly Members because, at the end of the day, we represent the same people in Wales, irrespective of whether we are Members of Parliament or Assembly Members.

Jon Owen Jones: I agree with the Secretary of State when he says that the Welsh Assembly should take those final decisions, but will he tell the House whether he has been privy to the results of the consultation that has taken place and whether he can make the analysis of those results available to the House? It is very unsatisfactory to debate a Bill on Report when we still do not know the results of the analysis of the consultation on which that Bill was brought about.

Paul Murphy: I am advised that that information has been placed in the Library and in the assembly's library. If that is not the case, I shall be happy to discuss the details of the results of that consultation with my hon. Friend and the Minister for Health and Social Services in Wales, but the point that I make is still valid. The way in which the restructuring will occur is the direct result of working with Members of Parliament and Assembly Members.
	Of course, the House will recall that my hon. Friend the Member for Bridgend set up the local health boards when he was Minister with responsibility for health in Wales. So the structure was started some years ago by a Labour Government working under the pre-devolution structures, but the assembly has now decided that this is the way to proceed, and we, in turn, have debated such matters in Committee and on the Floor of the House. That bodes well for the people of Wales, and I commend the Government amendments and hope that my hon. Friend will withdraw the amendment.

Win Griffiths: I have already said that I wanted to place on the record my view that Wales could manage perfectly well with 14 local health boards. The Bill will empower the Minister for Health and Social Security and the assembly to create between one and 22 boards, but I hope that they will listen to the suggestion that there should be 14 of them. On that basis, I am happy to beg to ask leave to withdraw the amendment.
	Amendment, by leave, withdrawn.

Clause 9
	 — 
	Funding of Local Health Boards

Amendment made: No. 75, in page 11, line 15, leave out "Trust" and insert "Board".—[Ms Blears.]

Clause 13
	 — 
	Commission for Health Improvement: inspections and investigations

Amendments made: No. 29, in page 18, line 40, after "(db)", insert—
	', or any functions equivalent to those under section 20(1)(c) prescribed under section 20(1)(e)'.
	No. 30, in page 18, line 45, at end insert—
	'( ) premises owned or controlled by a Local Health Board,'.
	No. 31, in page 19, line 3, leave out—
	'persons mentioned in paragraph (a) or (b) have'
	and insert—
	'an NHS body, a service provider or a Local Health Board has'.
	No. 32, in page 19, line 6, after "20(7)", insert "(disregarding section 20(8)(b))".—[Mr. Hutton.]

Clause 15
	 — 
	Establishment of Patients' Forums

Amendments made: No. 33, in page 20, line 22, at end insert—
	'( ) If, in the course of exercising its functions, a Patients' Forum becomes aware of any matter which in its view should be considered by a relevant overview and scrutiny committee, the Forum may refer that matter to the committee.'.
	No. 34, in page 20, line 45, at end insert—
	' "relevant overview and scrutiny committee", in relation to a Patients' Forum, means any overview and scrutiny committee in relation to which the Primary Care Trust or NHS trust for which the Forum is established is a local NHS body by virtue of regulations made under section 7(4) of the Health and Social Care Act 2001 (including that provision as read with section 8(5) and as applied by section 10(2) of that Act),'.—[Mr. Hutton.]

Clause 17
	 — 
	Annual reports

Amendments made: No. 35, in page 21, line 40, leave out "the" and insert "each".
	No. 36, in page 21, line 41, after "(i)", insert "any part of".
	No. 37, in page 22, line 1, leave out from "(d)" to end of line 5 and insert—
	'any relevant overview and scrutiny committee within the meaning given by section 15.'.—[Mr. Hutton.]

Clause 18
	 — 
	Supplementary

Amendments made: No. 38, in page 22, line 34, leave out—
	'NHS trust or Primary Care Trust for which it is established'
	and insert—
	'Commission for Patient and Public Involvement in Health'.
	No. 39, in page 22, line 43, at end insert—
	'( ) the referral of matters by a Patients' Forum to a relevant overview and scrutiny committee (within the meaning given by section 15).'.—[Mr. Hutton.]

Clause 23
	 — 
	The Council for the Regulation of Health Care Professionals

Amendments made: No. 76, in page 28, line 32, leave out "Part of this Act" and insert "group of sections".
	No. 77, in page 29, line 19, leave out "In subsection (1),".—[Mr. Hutton.]

Clause 25
	 — 
	Regulatory bodies and the Council

Amendment made: No. 40, in page 31, line 14, after "not)", insert—
	'or by the Department of Health, Social Services and Public Safety in Northern Ireland'.—[Mr. Hutton.]

Clause 27
	 — 
	Reference of disciplinary cases by Council to court

Amendments made: No. 41, in page 32, line 22, leave out paragraph (b).
	No. 42, in page 32, line 43, leave out "22(4)" and insert "22".
	No. 43, in page 32, line 44, leave out "of unacceptable professional conduct" and insert—
	'referred to the Professional Conduct Committee'.
	No. 44, in page 32, line 47, leave out "22(4)" and insert "22".
	No. 45, in page 33, line 2, at end insert—
	'(k) any corresponding measure taken in relation to a member of a profession regulated by the Professions Supplementary to Medicine Act 1960 (c.66) or, after the repeal of that Act by virtue of section 60(3) of the 1999 Act, by any such Order in Council under section 60 of the 1999 Act as is mentioned in section 23(3)(i).'.
	No. 46, in page 33, line 8, after "visitor,", insert—
	'or to any such person as is mentioned in subsection (1)(k)'.
	No. 47, in page 33, line 12, leave out "(j)" and insert "(k)".—[Mr. Hutton.]

Clause 29
	 — 
	Dentists

Amendments made: No. 48, in page 36, line 1, after "is", insert—
	'(or if he were registered would be)'.
	No. 49, in page 36, line 3, after "is", insert—
	'(or if he were registered would be)'.
	No. 50, in page 36, line 14, before "substitute", insert—
	'(in the case of an appeal against a determination under section 27 above or a direction under section 28 above)'.
	No. 51, in page 36, line 19, leave out "or the Health Committee" and insert—
	', the Health Committee or the Continuing Professional Development Committee'.
	No. 52, in page 36, line 21, after "above", insert—
	'or Schedule 3A to this Act'.
	No. 53, in page 36, line 40, at end insert—
	'(5) In section 34A of the Dentists Act 1984 (c.24) (professional training and development requirements), in subsection (7)(b), for "to Her Majesty in Council" there is substituted "under section 29 above to the relevant court".
	(6) Subsection (5) has effect—
	(a) upon the coming into force of this section, if that happens after the coming into force of article 8 of the Dentists Act 1984 (Amendment) Order 2001 (S.I. 2001/3926) ("the Dentists Order") so far as that article effects the insertion into the Dentists Act 1984 (c.24) of the new section 34A(7)(b),
	(b) otherwise, immediately after the coming into force to that extent of that article.
	(7) If this section comes into force before article 10(3) of the Dentists Order—
	(a) paragraphs (b), (c) and (d) of article 10(3) of that Order are revoked upon the coming into force of this section, and
	(b) until the coming into force of the remainder of article 10(3) of that Order, section 29 of the Dentists Act 1984 (c.24) (as amended by this section) is to be read with the modifications set out in subsection (8).
	(8) The modifications are that section 29 is to be read as if—
	(a) in each of paragraphs (a) and (b) of subsection (1A), the words "(or if he were registered would be)" were omitted,
	(b) in paragraph (c) of subsection (3), the words "(in the case of an appeal against a determination under section 27 above or a direction under section 28 above)" were omitted, and
	(c) in paragraph (d) of subsection (3)—
	(i) for the words ", the Health Committee or the Continuing Professional Development Committee" there were substituted "or the Health Committee", and
	(ii) the words "or Schedule 3A to this Act" were omitted.'.—[Mr. Hutton.]

Clause 40
	 — 
	Short title, interpretation, commencement and extent

Amendments made: No. 78, in page 43, line 31, leave out "and".
	No. 79, in page 43, line 33, leave out from beginning to end of line 36 and insert—
	' "NHS trust" has the same meaning as in the 1977 Act.'.—[Mr. Hutton.]

Schedule 1
	 — 
	English Health Authorities: Change of Name

Amendments made: No. 80, in page 46, line 5, leave out "sections 11 to 17" and insert "preceding provisions".
	No. 81, in page 47, line 42, leave out "Authority or" and insert "Authority,".—[Mr. Hutton.]
	Amendments made: No. 54, in page 48, line 38, leave out sub-paragraph (2).
	No. 55, in page 48, line 42, leave out—
	'in paragraph 16 (in both places) and'.—[Mr. Hutton.]

Schedule 2
	 — 
	Reallocation of Functions of Health Authorities to Primary Care Trusts

Amendment made: No. 82, in page 58, line 9, leave out "before "Health Authority"" and insert—
	'after "Strategic Health Authority," (inserted by paragraph 28(d) of Schedule 1 to this Act)'.—[Mr. Hutton.]
	It being 10 o'clock, Mr. Speaker then proceeded to put forthwith the Questions necessary for the disposal of the business to be concluded at that hour, pursuant to Order [20 November 2001].
	Remaining Government amendments agreed to.
	Motion made, and Question put, That the Bill be now read the Third time.
	The House divided: Ayes 324, Noes 201.

Question accordingly agreed to.
	Bill read the Third time, and passed.

SITTINGS IN WESTMINSTER HALL

Motion made,
	That, following the Order of 20th November 2000, Mr. Nicholas Winterton, Mr. John McWilliam, Mr. Frank Cook and Mr. Edward O'Hara be appointed to act as additional Deputy Speakers at sittings in Westminster Hall during this Session.—[Mrs. McGuire.]

Hon. Members: Object.

PETITION
	 — 
	Houghton Regis

Andrew Selous: I am grateful for the opportunity to present this petition to the House. It has been signed by 658 of my constituents from the town of Houghton Regis in Bedfordshire, which has a population of some 17,000 people but, at present, does not have a bank. That is particularly injurious to my constituents because transport to the neighbouring towns is difficult and slow; a large number of elderly people in Houghton Regis need access to a bank. Bank premises in the town are vacant and available for use. The British Bankers Association is conducting a pilot study to reintroduce banks to areas but, unfortunately, Houghton Regis does not qualify. The petition states:
	The Petitioners therefore request that the House of Commons urge the British Banking Association to include Houghton Regis in its counter-sharing pilot scheme.
	And the Petitioners remain, etc.
	To lie upon the Table.

SCHOOL PLACES (EAST SUSSEX)

Motion made, and Question proposed, That this House do now adjourn.—[Mrs. McGuire.]

Nigel Waterson: I cannot help but feel a certain irony in taking part in this debate, as I spoke in last Friday's debate on pensions and annuities. However, Eastbourne is like that; we have a large elderly population but, as I shall describe, we also have a fast-growing population of young people, which is estimated to continue well into this century. As I am sure you do, Mr. Speaker, I have a personal rule of thumb; if I am not getting angry letters about something, it is probably okay and there is not a problem.
	Increasingly, in recent years I have been getting letters from disappointed parents who cannot get their children into the school of their choice. In East Sussex, parents are given three choices—the local education authority prefers to call them preferences, but I think that that is a distinction without any difference. On a number of occasions of which I am aware—no doubt there have been others—parents have not got their children into any of their three choices. I am so concerned about resources and the allocation of school places in my constituency that I have recently announced a programme to revisit all its schools in the coming months to see the problems for myself.
	There is a problem in the primary schools. According to the briefing that the LEA kindly provided, in the East Sussex school organisation plan—SOP—for 2002 to 2005–06, the number of primary age pupils, which has grown substantially, will decline in the county as a whole. In Eastbourne, however, the total number of primary age pupils is expected to increase by about 100 in the next two years. There is already a problem in primary schools. I believe that Ocklynge junior school in my constituency is the largest junior school not just in the country, but in Europe. Only the other day, I visited Stafford junior school in my constituency, which is being pressured to take a total of 370 pupils, when it was originally designed to take a maximum of 280. I saw for myself the four mobile classrooms—I hesitate to use the word "temporary" as it is often misused in the circumstances—in its grounds.
	The problem is therefore widespread at every level of education in my constituency and in other parts of East Sussex. I have reached the conclusion that in the medium term we need another new school in Eastbourne, or at least a major extension of one or more of the existing schools. The SOP shows a continuing marked increase of some 1,200 in the number of secondary-age pupils across the county over the plan period. However, in Eastbourne it is expected that the total number of secondary-age pupils will increase by more than 600, or almost 12 per cent., during the period of the plan.
	A working group chaired by the lead member for education, Councillor Rupert Simmons, concluded that taking into account likely new housing that the Government seek to impose on the area, 700 new places will be required. The group concluded that up to 350 new places will certainly be needed by 2005. A number of options have been identified.
	That is not to say that there is no good news. We have the £16 million committed by the county council to the new secondary school, the Causeway school, which will provide up to 950 places. The Church of England-aided school, Bishop Bell, is about to commence a £2 million project to provide 150 additional places. I should mention in passing that Bishop Bell is the most oversubscribed school in the entire county, largely owing to the efforts of its excellent head teacher, Mr. Terry Boatwright.
	I am pleased to say that in only a few short months, the new Conservative administration in East Sussex has got a grip under Councillor Simmons's leadership and is looking at priorities, which was not achieved during the previous eight years of Liberal Democrat control. In particular, the previous administration seems to have ignored the view of the district auditor in his report in 1998, which stated that the margin for parental preference in Eastbourne was very small.
	The figures are extraordinary. With the exception of the new Causeway school, which is still in the process of filling up, every secondary school in my constituency is well over capacity, with percentages ranging from 8 per cent. up to 19 per cent. In the case of the Eastbourne technology college, formerly Hampden Park school, the LEA and the governors are allowing for the possibility of it being up to 26 per cent. over capacity. That shows an enormous pressure on school places and on staff and pupils.
	It is true that there are vacant places in Eastbourne, but it is also true that, without exception, they all exist at Eastbourne technology college. That is interesting for two reasons. First, ETC is already 19 per cent. over capacity. Secondly, for reasons that may not be fair, may be historical and are beyond the scope of this debate, Eastbourne technology college is currently not a popular school, in the sense of attracting as many first preferences as some other secondary schools.
	That causes an additional problem. Despite the excellent work of the staff, and particularly the relatively new head teacher, Janet Felkin, there are parents whose children are assigned to Eastbourne technology college although it was not one of their three preferences, and who are not happy about that situation. That is the only school, as confirmed by the director of education, Denise Stokoe, that has spare places. She states in her letter to me:
	"As you can see, there are sufficient places in the town overall. There is a particular problem that all the spare places are at one school."
	Councillor Simmons remarked in an e-mail to me on the matter that the council has set out the basis of a development plan, brought together all the six secondary heads involved, and is seeking to devise a plan. He says:
	"Mobile Huts can bail us out of a temporary situation but only for so long. Willingdon"—
	that is, Willingdon school—
	"are running with 20 now and all in a poor condition."
	He goes on to talk about an extremely limited capital budget. All those issues will be addressed at a meeting of the council's cabinet on 31 January.
	An interesting option that emerged only today in a press statement from the LEA is that of moving the existing Cavendish school to what is effectively a greenfield site at Cross Levels way to give the school up-to-date facilities and, perhaps even more important, to increase its size to about 1,200 places. As the statement makes clear, councillors have yet to make decisions about resources for the forward capital programme. It states:
	"At this stage, there can be no guarantee of funding for the plan."
	This is a question not merely of numbers, however, but of the real human problems caused by the figures. For example, Mr. Keith Martin, one of my constituents, has fought a tenacious battle to try to get his daughter Claire into the school of his and his wife's choice. That has not been possible and they have been offered a place at Eastbourne technology college. Claire is still being tutored at home at great expense and inconvenience to all concerned. There seems to be a state of impasse at the moment as far as her education is concerned.
	The other day, a local teacher sent me an e-mail that stated:
	"Morale has never been so low in all my 31 years of teaching. The paperwork and bureaucracy mean that we are working every evening and weekends to complete so many meaningless documents that are not helping the children one jot."
	She went on to write:
	"I urge you to revisit . . . schools in your constituency and find out just how underfunded they all are . . . Oldies like myself are counting the years until we retire . . . Now everything has become prescriptive and the joy has gone out of teachers' lives."
	That is a crushing indictment of the current system.
	We have a worrying picture of the effect of the current situation on class sizes, the pressures on teachers, the possible prejudice to the education of local children in Eastbourne and elsewhere in East Sussex and the undermining of parental choice. I have three questions for the Minister. First, does she accept the scale of the pressures that I have described and agree that they must be addressed? Secondly, does she accept that, in the short term, the problems of the existing facilities, such as temporary classrooms, must be tackled? Thirdly, does she accept that, in the medium term, my constituents need either another new secondary school or significant extensions to one or more existing schools and that the planning for that development, whichever option is adopted, must start now? I want to be able to go back to my constituents, such as Mr. Martin and many others, and give them reassuring answers to those questions after tonight's debate.

Margaret Hodge: I congratulate the hon. Member for Eastbourne (Mr. Waterson) on securing this debate. I am delighted to hear that he is undertaking a programme of visiting his local schools. I must admit that I am surprised that that is not a regular part of what he chooses to do. Even speaking as one of us busy Ministers, I can say that I make it a point in my schedule to ensure that I regularly visit schools. Indeed, there is never a time when a school has not seen me within about 18 months.

Nigel Waterson: If the Minister had been listening with her usual care, she would have heard me use the word "revisit".

Margaret Hodge: I heard the word "revisit", but I am none the less surprised because regular visits are a feature of my constituency duties. I hope that all Members of Parliament show such interest in the educational infrastructure of their constituencies.
	I welcome the debate because it gives us an opportunity to put on record our approach to ensuring a framework that provides choice and opportunity for children and their families. I understand and sympathise with the anxieties that the hon. Gentleman's constituents have expressed in correspondence. It is proper to raise them in the House, and I am delighted that he has done that.
	I hope that the hon. Gentleman accepts that many solutions to the problems that he has raised are in the hands of the Conservative-controlled local education authority and local people. We have properly made it their job to plan for and provide the necessary places so that parents and children can enjoy the choice that he wishes them to have. After the debate, I hope that he will go back to his colleagues on the local education authority and encourage them to get on with planning to ensure that proper bids are submitted to the Department so that we can respond to the needs that he has highlighted.
	Tonight's debate allows me to explain the national context in which local decisions about the allocation of school places are made. It also gives me the opportunity to outline our proposals in the Education Bill, which is currently being considered in Committee, and to explain how they will reinforce our priorities and ensure choice in local communities.
	Since we have been in government, we have made clear our overriding commitment to improving educational standards. We aim to ensure that parents and children have a choice and the best way of doing that is through equally good schools. That is vital to making equality of opportunity and parental choice a reality.
	My hon. Friend the Under-Secretary of State for Education and Skills, the hon. Member for Bury, South (Mr. Lewis), who is present, is dealing with the Bill in Committee. Its focus is the transformation of our secondary schools, which the hon. Member for Eastbourne mentioned. I want to draw his attention to several proposals in the Bill that will support his aspirations for his local community.
	We propose to expand the successful specialist schools programme, which will help to extend diversity, and hence choice, in secondary schools. Schools ready for specialist status will be encouraged to seek it, and we will support those who are working towards it.
	Successful schools will be encouraged to excel and innovate. We intend to give the best schools greater freedom—for example, to take new approaches to staffing, or to accelerated learning.
	We are establishing a schools innovation unit to work with teachers and heads, and to help stimulate and disseminate new ideas, especially in relation to catering better for pupils' different requirements and aspirations.
	We hope that governing bodies in the hon. Gentleman's area will be able to work together to create families of local schools, sharing problems and pooling resources in everyone's best interests. Those proposals will help us to raise standards, which will help to enhance opportunity and create choice.
	We are responding to the wishes of many parents who try to ensure that successful and popular schools are able to expand more easily. That is especially relevant to the hon. Gentleman's anxieties. The governing bodies of successful schools will be able to appeal to the adjudicator if their proposals for expansion are turned down by the school organisation committee.
	In the Bill, we not only focus on how to encourage and support best schools, but recognise the need to tackle low standards in schools. The hon. Gentleman talked about the lack of popularity of Eastbourne technology college. I hope that some of the measures that we are introducing will support improvements in quality and standards in all schools in his constituency.
	Schools that face challenging circumstances will receive a programme of support, with the aim of setting a floor and ensuring that a specific number of pupils at every school obtain five GCSEs at grade A to C by 2006. It is to East Sussex local education authority's credit that only one of its schools fell within the category of challenging schools—that is, those in which 25 per cent. or fewer pupils gained five or more GCSEs at A* to C grade. I am pleased to say that that school improved its performance in 2001, with 30 per cent. of its pupils having achieved 5 GCSEs at grade A* to C.
	Local education authorities will invite—or, if necessary, be instructed to invite—external partners to help turn around failing schools. None of our plans to improve standards can come to fruition unless we have sufficient well trained, well motivated teachers in place. The one letter that the hon. Gentleman chose to read to the House does not, in my view, reflect the feeling of most teachers, who recognise that we are investing as best we can to ensure that they can focus on the job that they do best, and for which they are trained, which is teaching. I hope that the hon. Gentleman will support our proposals to modernise the teaching profession.
	Teacher recruitment and retention is a key issue to us. In the lifetime of this Parliament, we will recruit 10,000 more teachers and the crucial 20,000 more support staff who will support them in their administrative work, much of which is necessary if we are properly to monitor the fact that we are raising standards in schools. We have doubled the money given to East Sussex local education authority last year for recruitment and retention of teachers. In 2002-03, it will receive £703,000. How that is spent will be determined locally, and I hope that it will be spent wisely to improve recruitment and retention.
	I now want to respond to the specific local concerns expressed by the hon. Gentleman. The law gives parents the right to express a preference for the school at which they wish their child to be educated, but it has never guaranteed every parent a place for their child at the school of their choice. I understand the frustration of parents whose application has been unsuccessful. Indeed, in my time, I have shared that frustration. However, if a school has more applications than places, it cannot admit every applicant. In those circumstances, places have to be allocated among applicants according to a local education authority's published oversubscription criteria. Some schools have always been more popular than others.
	LEAs have a duty to provide sufficient school places for their area. We believe that decisions about the organisation of school places are best taken locally by the people who know the area. That is why, through the School Standards and Framework Act 1998, we established a new framework for local decision making. LEAs now have a duty to prepare a school organisation plan covering a five-year period, and that has to be a rolling programme. The plan sets out how the LEA proposes to deal with surpluses and deficits of school provision, and what provision it intends to make for pupils with special educational needs.
	Independent school organisation committees have also been established for each LEA area. Their role is to consider the plans and to take decisions about statutory proposals affecting the local organisation of school places. School organisation committees are independent statutory bodies answerable to their local communities. If any LEA is able to demonstrate an overall deficit in school places, it can apply for funding in the annual capital round. I urge the hon. Gentleman to return to his local education authority and tell it to get on with putting in such an application.
	Our officials are aware of the pressures on school places in East Sussex, but finding a solution to those pressures is an issue that has to be addressed by the local education authority, and through the local school organisation committee. I am sure that the hon. Gentleman would agree that it would be completely wrong of the Government to impose a solution centrally. It must be the responsibility of the local education authority to come forward with its preferred solution. I concur with the figures that the hon. Gentleman put before the House. We have figures showing more than 1,000 surplus primary school places in East Sussex, and a shortfall of around 270 secondary school places.
	The LEA has shown in its projections that demand for places will continue to increase over the next three or four years, particularly in the secondary sector. In the hon. Gentleman's constituency of Eastbourne, it also forecasts a continuing increase in demand for primary school places in the next two years, but that will decline.
	As the hon. Gentleman rightly said, the growing pressure on secondary schools is a concern, but as he also noted, officers and local head teachers have been working together to analyse the information and consider ways to meet the pressure on them. They estimate that they need about 700 extra secondary school places by 2010, although about half must be available by 2005. I hope that the council will shortly consider the four-year capital programme for the Eastbourne area alone.
	I am pleased that the LEA has added capacity through the phased expansion schools, such as the Causeway school, which, as the hon. Gentleman said, has increased its numbers to 600 pupils. It will eventually accommodate 900. We support the LEA's requirement to meet the demand for places through basic need funding.
	Throughout the county, including Eastbourne, a large number of new homes are planned or under construction. That is a healthy development in any locality. I am surprised that the hon. Gentleman thinks that the Government are not responding to the capital pressures arising from providing additional places in his constituency. This Government, more than any other in my memory, have put more money into capital initiatives and ensured better investment, despite the huge backlog that we inherited. There is no reason to suggest that we have in any way inhibited the necessary expansion of places in East Sussex. The onus lies with the LEA to make appropriate proposals that it can justify in relation to the extra demand.
	To give an example, we have already committed £10.5 million for an additional 292 primary, 1,273 secondary and 49 post-16 places between the 1999–2000 and 2001–02 financial years. We have just committed a further £10.98 million of basic need funding for 2002–03 to 2004–05, to provide an additional 247 primary and 1,012 secondary places. That allocation fully meets the LEA's bid to us for basic need funding for primary and secondary school places, and it shows our commitment to work constructively with the LEA. However, I again urge the hon. Gentleman to ask his colleagues in the LEA to get on with making appropriate proposals to us.
	On the secondary sector, I have mentioned the expansion at the Causeway school; Bishop Bell Church of England school is also being expanded for 2002–03. If the council cabinet agrees to the proposals put to it for further capital programmes, more places should be available from 2003. The LEA and its schools must continue to work in partnership to monitor and plan to meet the need for additional provision.
	The hon. Gentleman spoke of the need to replace temporary classrooms. I fully agree that schools must have accommodation that is fit for purpose, providing an environment in which schools can work effectively and children can learn. That is why we have greatly increased capital investment in schools since we came to office. In the past four years, we have made £5.3 billion available and a further £8.5 billion is being made available over the next three years. By 2003–04, annual capital investment will be £3.5 billion.
	That commitment will allow LEAs and schools to make real progress in modernising schools so that they are fit for the 21st century. That includes replacing temporary facilities that are no longer suitable, but I stress again that the onus lies with the LEA to put sensible, workable propositions to us.
	The Government have made a real commitment to investment in schools. We have made real progress in driving up standards in all our schools. We have set out an agenda for change, especially at secondary school level, that will deliver an education through the years of compulsory schooling that is fit for the new millennium. The cumulative effect of those numerous initiatives will be to raise standards so that ultimately the choice that parents will have to make should be between good schools, rather than between good schools and schools that need to improve.
	While the Government can facilitate and support progress, establish an appropriate framework and provide proper funding, the onus to deliver properly for local people must rest with local LEAs. We would expect them to respond appropriately to pressures on demand, and to plan and provide enough places for children in their areas.
	Question put and agreed to.
	Adjourned accordingly at fifteen minutes to Eleven o'clock.